Provider Demographics
NPI:1013912179
Name:DELAND-REEVES, CHRISTINA JEAN (MD)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:JEAN
Last Name:DELAND-REEVES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45123-9780
Mailing Address - Country:US
Mailing Address - Phone:937-981-9444
Mailing Address - Fax:937-981-9448
Practice Address - Street 1:1075 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:OH
Practice Address - Zip Code:45123
Practice Address - Country:US
Practice Address - Phone:937-981-9444
Practice Address - Fax:937-981-9448
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-082754207Q00000X
OH3582754207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2422597Medicaid
OHH88515Medicare UPIN
OHH050600Medicare PIN