Provider Demographics
NPI:1700889342
Name:REINES, ERIC DAVID (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:DAVID
Last Name:REINES
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 1:6300 STEVENSON AVE
Mailing Address - Street 2:STE D
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-3554
Mailing Address - Country:US
Mailing Address - Phone:703-212-8750
Mailing Address - Fax:703-212-8752
Practice Address - Street 1:6300 STEVENSON AVE
Practice Address - Street 2:STE D
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-3554
Practice Address - Country:US
Practice Address - Phone:703-212-8750
Practice Address - Fax:703-212-8752
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101042618207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
503960OtherNCPPO
4091754OtherAETNA HEALTHCARE PLANS
DC523402A64OtherMEDICARE ID
215373OtherMDIPA/ALLIANCE PPO PLANS
VA6034284Medicaid
VA097555OtherANTHEM BCBS
A582-0001OtherBCBS PLANS
VA6034284Medicaid
503960OtherNCPPO