Provider Demographics
NPI:1740221407
Name:REYNOLDS, PATRICIA S (PAC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:S
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 SENTARA CIR
Mailing Address - Street 2:SUITE 320
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-5716
Mailing Address - Country:US
Mailing Address - Phone:757-345-4800
Mailing Address - Fax:757-345-4801
Practice Address - Street 1:400 SENTARA CIR
Practice Address - Street 2:SUITE 320
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-5716
Practice Address - Country:US
Practice Address - Phone:757-345-4800
Practice Address - Fax:757-345-4801
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110003329363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP24871Medicare UPIN