Provider Demographics
NPI:1457337768
Name:REAVES, ALVIN L (MD)
Entity Type:Individual
Prefix:
First Name:ALVIN
Middle Name:L
Last Name:REAVES
Suffix:
Gender:M
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:PO BOX 1245
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29116-1245
Mailing Address - Country:US
Mailing Address - Phone:803-395-4561
Mailing Address - Fax:803-395-2237
Practice Address - Street 1:3000 SAINT MATTHEWS RD
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-1442
Practice Address - Country:US
Practice Address - Phone:803-395-2200
Practice Address - Fax:803-395-2237
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23597207RH0002X, 208M00000X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7660303OtherAETNA
SC183343OtherMEDCOST
SC0635330OtherCIGNA
SC20048503OtherFIRST CHOICE
SCT78207Medicaid
SC20048503OtherFIRST CHOICE
SC0635330OtherCIGNA
SCH487167399Medicare ID - Type Unspecified