Provider Demographics
NPI:1629114103
Name:REEVE, DOUGLAS (PA)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:REEVE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 AKERS FARM RD
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-4863
Mailing Address - Country:US
Mailing Address - Phone:540-382-3440
Mailing Address - Fax:540-382-7240
Practice Address - Street 1:120 AKERS FARM RD
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-4863
Practice Address - Country:US
Practice Address - Phone:540-382-3440
Practice Address - Fax:540-382-7240
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0850026626363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK24755Medicare PIN
ILS41953Medicare UPIN
S41953Medicare UPIN
IL6447860011Medicare NSC
ILIL3270493Medicare PIN