Provider Demographics
NPI:1760456107
Name:REESE, MITCHELL S (MD)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:S
Last Name:REESE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1508 WILLOW LAWN DR
Mailing Address - Street 2:STE 117
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3421
Mailing Address - Country:US
Mailing Address - Phone:804-282-8102
Mailing Address - Fax:804-282-3744
Practice Address - Street 1:1508 WILLOW LAWN DR
Practice Address - Street 2:STE 117
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3421
Practice Address - Country:US
Practice Address - Phone:804-282-8102
Practice Address - Fax:804-282-3744
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01010284392085B0100X, 2085N0700X, 2085N0904X, 2085P0229X, 2085R0202X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007201401Medicaid
VA007238860Medicaid
VA224564OtherANTHEM
VA007216246Medicaid
VA010132908Medicaid
VA007201435Medicaid
VA010250064Medicaid
VA007216246Medicaid
VA007238860Medicaid