Provider Demographics
NPI:1285614404
Name:REEDY, DENNIS W (MD)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:W
Last Name:REEDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 CAMPUSWOOD DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057
Mailing Address - Country:US
Mailing Address - Phone:315-234-6677
Mailing Address - Fax:315-234-4808
Practice Address - Street 1:5000 CAMPUSWOOD DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057
Practice Address - Country:US
Practice Address - Phone:315-234-6677
Practice Address - Fax:315-234-4808
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1954661207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01744729Medicaid
NYBB6823Medicare ID - Type Unspecified
NY01744729Medicaid
NYBB2212Medicare ID - Type Unspecified