1790753325 NPI number — ROBERT L REID M.D.

Table of content: ROBERT L REID M.D. (NPI 1790753325)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790753325 NPI number — ROBERT L REID M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REID
Provider First Name:
ROBERT
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790753325
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3040 WILLIAMS DR STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRFAX
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22031-4618
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
571-350-8400
Provider Business Mailing Address Fax Number:
703-940-8697

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8613 LEE HWY # 200N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRFAX
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22031-2171
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-208-3155
Provider Business Practice Location Address Fax Number:
703-280-9596
Provider Enumeration Date:
03/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  0101053857 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 504740 . This is a "NCPPO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 541795091 . This is a "PHCS PPO/POS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0870-010 . This is a "BCBS NCA - CARE FIRST" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 500617-824248 . This is a "AETNA HMO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 3600353 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 316256-244725 . This is a "MAMSI/OP CHOICE/ALLIANCE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 223807 . This is a "KAISER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 284759 . This is a "TRIGON/ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 4545490004 . This is a "CIGNA POS/PPO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 541795091 . This is a "TRICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 541795091 . This is a "FX CTY COMM HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1790753225 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4545490004 . This is a "CIGNA HMO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 500617-5600455 . This is a "AETNA PPO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 541795091 . This is a "FIRST HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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