Provider Demographics
NPI:1801887443
Name:REESE, DANITA A (MD)
Entity type:Individual
Prefix:
First Name:DANITA
Middle Name:A
Last Name:REESE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 357
Mailing Address - Street 2:702 PLANK ROAD
Mailing Address - City:SOUTH HILL
Mailing Address - State:VA
Mailing Address - Zip Code:23970-0357
Mailing Address - Country:US
Mailing Address - Phone:434-447-3395
Mailing Address - Fax:434-447-4979
Practice Address - Street 1:702 PLANK RD
Practice Address - Street 2:
Practice Address - City:SOUTH HILL
Practice Address - State:VA
Practice Address - Zip Code:23970-2414
Practice Address - Country:US
Practice Address - Phone:434-447-3395
Practice Address - Fax:434-447-4979
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0103000943213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA105423OtherANTHEM BCBS VA
VA0964320001OtherDMEPOS CIGNA GOV. SERVICE
VA26977OtherOPTIMA HEALTH
VA480018496OtherRAILROAD MEDICARE
NC890801VMedicaid
VA010066573Medicaid
VA010066573Medicaid
VA480018496OtherRAILROAD MEDICARE