Provider Demographics
NPI:1184207896
Name:REESMAN, JOHN M
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:M
Last Name:REESMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 FAIRMONT AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-2166
Mailing Address - Country:US
Mailing Address - Phone:681-758-4223
Mailing Address - Fax:267-937-4675
Practice Address - Street 1:1097 GREENBAG RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-1532
Practice Address - Country:US
Practice Address - Phone:304-291-9066
Practice Address - Fax:304-291-3347
Is Sole Proprietor?:No
Enumeration Date:2021-04-30
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant