Provider Demographics
NPI:1710911193
Name:REID, JAMES R IV (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:REID
Suffix:IV
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:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1850 ROSSER AVE
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-3237
Practice Address - Country:US
Practice Address - Phone:540-942-1200
Practice Address - Fax:540-942-0151
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101047048207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5610869Medicaid
VA244439OtherANTHEM
VA080007545Medicare PIN
VA244439OtherANTHEM