Provider Demographics
NPI:1942613856
Name:BLACKWOOD, REINA L (MD)
Entity Type:Individual
Prefix:DR
First Name:REINA
Middle Name:L
Last Name:BLACKWOOD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:REINA
Other - Middle Name:LUCILLE
Other - Last Name:BLACKWOOD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2859 VIRGINIA BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7613
Mailing Address - Country:US
Mailing Address - Phone:757-395-1300
Mailing Address - Fax:
Practice Address - Street 1:2859 VIRGINIA BEACH BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7613
Practice Address - Country:US
Practice Address - Phone:757-395-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP03185207Q00000X
VA0101268005207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIRES000Medicare UPIN