1023083615 NPI number — DR. ELIZABETH THOMAS REEVES M.D., M.P.H.

Table of content: DR. ELIZABETH THOMAS REEVES M.D., M.P.H. (NPI 1023083615)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023083615 NPI number — DR. ELIZABETH THOMAS REEVES M.D., M.P.H.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REEVES
Provider First Name:
ELIZABETH
Provider Middle Name:
THOMAS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D., M.P.H.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THOMAS
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
KATHERINE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1023083615
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
KIMBROUGH AMBULATORY CARE CENTER
Provider Second Line Business Mailing Address:
2480 LLEWELLYN AVENUE
Provider Business Mailing Address City Name:
FORT GEORGE G. MEADE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20755-7081
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-677-8751
Provider Business Mailing Address Fax Number:
301-677-8013

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
KIMBROUGH AMBULATORY MEDICAL CENTER
Provider Second Line Business Practice Location Address:
2480 LLEWELLYN AVENUE
Provider Business Practice Location Address City Name:
FORT GEORGE G. MEADE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20755
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-677-8800
Provider Business Practice Location Address Fax Number:
301-677-8013
Provider Enumeration Date:
02/17/2006

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: 2083P0901X , with the licence number:  0101235676 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 0101235676 , 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)