Provider Demographics
NPI:1942408893
Name:REATH, VIRGINIA (RPA MPH)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:
Last Name:REATH
Suffix:
Gender:F
Credentials:RPA MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 SULLIVAN
Mailing Address - Street 2:#22
Mailing Address - City:NYC
Mailing Address - State:NY
Mailing Address - Zip Code:10012
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25 5TH AVE
Practice Address - Street 2:VILLAGE FAMILY PRACTICE
Practice Address - City:NYC
Practice Address - State:NY
Practice Address - Zip Code:10012
Practice Address - Country:US
Practice Address - Phone:212-477-1750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001097363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant