Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | OT017720 | PA |
Y | 207QS0010X | Family Doctor - Sports Medicine | H0091778 | MD |
NPI | 1134654452 |
---|---|
Provider Name | Ryan Michael Reese |
First Address | Columbia, MD 21045-2617 |
Second Address | Columbia, MD 21045-2617 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2017 |
Last Update Date | 10/08/2021 |