Provider Demographics
NPI:1679754188
Name:REAVES, JARED WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:WAYNE
Last Name:REAVES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6029 WATCH CHAIN WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-4714
Mailing Address - Country:US
Mailing Address - Phone:877-306-2217
Mailing Address - Fax:
Practice Address - Street 1:10816 HICKORY RIDGE RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3622
Practice Address - Country:US
Practice Address - Phone:877-306-2217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101249265208100000X
MDD0074865208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA-017OtherTRICARE/CHAMPUS
VAPAROtherVIRGINIA HEALTH NETWORK
NC5917488Medicaid
VA1679754188Medicaid
VAPAROtherCORVEL
VAPAROtherUNITED HEALTHCARE/MAMSI
VAPAROtherCIGNA
VA10078676OtherOPTIMA HEALTH
VAPAROtherUSA MANAGED CARE
VAPAROtherVIRGINIA PREMIER HEALTH PLAN
VAPAROtherMULTIPLAN
VA1679754188OtherFIRST HEALTH NETWORK/COVENTRY HEALTH/SOUTHERN HEALTH
VA438177OtherANTHEM BC/BS
VAPAROtherAETNA
VAVV2688AMedicare PIN