Basic Information
Provider Information | |||||||||
NPI: | 1770562050 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | REESE | ||||||||
FirstName: | DANIEL | ||||||||
MiddleName: | B | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 220 CAMPUS BLVD STE 100 | ||||||||
Address2: |   | ||||||||
City: | WINCHESTER | ||||||||
State: | VA | ||||||||
PostalCode: | 226012896 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5405365100 | ||||||||
FaxNumber: | 5405360235 | ||||||||
Practice Location | |||||||||
Address1: | 1880 AMHERST STREET | ||||||||
Address2: | SUITE 100 AND SUITE 200 | ||||||||
City: | WINCHESTER | ||||||||
State: | VA | ||||||||
PostalCode: | 226012872 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5406620306 | ||||||||
FaxNumber: | 8552642066 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/13/2006 | ||||||||
LastUpdateDate: | 09/14/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 09/14/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0011X | 0101057244 | VA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
ID | Type | State | Issuer | Description | C00075 | 01 | VA | MEDICARE GROUP | OTHER | 0210035000 | 05 | WV |   | MEDICAID | 2119597 | 01 | VA | MAMSI | OTHER | 43946 | 01 | VA | OPTIMA HEALTH SENTARA | OTHER | 9318661 | 01 | WV | MEDICARE GROUP | OTHER | 000385004 | 01 | WV | MOUNTAIN STATE BCBS | OTHER | 005822823 | 05 | VA |   | MEDICAID | 233672 | 01 | VA | ANTHEM BCBS | OTHER | 502806 | 01 | VA | NCPPO | OTHER |