Provider Demographics
NPI:1376842948
Name:REEVE, KENNETH (DO)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:REEVE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1459A NEW BRITAIN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06110-1659
Mailing Address - Country:US
Mailing Address - Phone:860-232-5437
Mailing Address - Fax:860-232-2110
Practice Address - Street 1:1459A NEW BRITAIN AVE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06110
Practice Address - Country:US
Practice Address - Phone:860-232-5437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-22
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO1886208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics