Provider Demographics
NPI:1952720690
Name:REISER, PAMELA CRUZ (MD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:CRUZ
Last Name:REISER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:PAMELA
Other - Middle Name:MARIE
Other - Last Name:CRUZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-397-6344
Mailing Address - Fax:757-606-1185
Practice Address - Street 1:3640 HIGH ST STE 3B
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-3213
Practice Address - Country:US
Practice Address - Phone:757-397-6344
Practice Address - Fax:757-606-1185
Is Sole Proprietor?:No
Enumeration Date:2014-04-09
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101262278207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAFS6729240OtherDEA