Provider Demographics
NPI:1114012747
Name:REESE, CHARLES (CRNA, PHD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:REESE
Suffix:
Gender:M
Credentials:CRNA, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 91734
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23291-1734
Mailing Address - Country:US
Mailing Address - Phone:804-358-6100
Mailing Address - Fax:804-342-7619
Practice Address - Street 1:1250 E MARSHALL STREET
Practice Address - Street 2:ANESTHESIA CRNA
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-0509
Practice Address - Country:US
Practice Address - Phone:804-628-6975
Practice Address - Fax:804-628-6997
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024133027367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA000704M42Medicare ID - Type UnspecifiedC03042