Provider Demographics
NPI:1912095019
Name:REISNER, DARRELL STEVEN (MD)
Entity Type:Individual
Prefix:
First Name:DARRELL
Middle Name:STEVEN
Last Name:REISNER
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 1:224D CORNWALL ST NW STE 403
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-2704
Mailing Address - Country:US
Mailing Address - Phone:703-737-6010
Mailing Address - Fax:703-443-8643
Practice Address - Street 1:21475 RIDGETOP CIR STE 300
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-8580
Practice Address - Country:US
Practice Address - Phone:703-430-4400
Practice Address - Fax:703-430-4130
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101055065207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1912095019Medicaid
VA30015419120001Medicaid
MD4264002-00Medicaid
VA284214OtherANTHEM BCBS/HEALTHKEEPERS
VA180036603Medicare ID - Type UnspecifiedRAILROAD MEDICARE
VA6307361Medicaid
VA6307396Medicaid
VA180000814Medicare ID - Type UnspecifiedTRAILBLAZERS CENTRAL VA
MD4264002-00Medicaid
VA6307388Medicaid
VAG99797Medicare UPIN
VA6307370Medicaid
VA284213OtherANTHEM BCBS/HEALTHKEEPERS
VA0858550001Medicare NSC