Provider Demographics
NPI:1689788952
Name:REEVES, GLORIA MARTA (MD)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:MARTA
Last Name:REEVES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 W PRATT ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1023
Mailing Address - Country:US
Mailing Address - Phone:410-328-5881
Mailing Address - Fax:410-328-8552
Practice Address - Street 1:701 W PRATT ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1023
Practice Address - Country:US
Practice Address - Phone:410-328-5881
Practice Address - Fax:410-328-8552
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00557642084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD404511400Medicaid
MDH62203Medicare UPIN
MDD653Medicare PIN