Basic Information
| Provider Information | |||||||||
| NPI: | 1184690935 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REID | ||||||||
| FirstName: | YOLANDA | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1460 | ||||||||
| Address2: | |||||||||
| City: | FREDERICKSBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 224021460 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5407862100 | ||||||||
| FaxNumber: | 5407866673 | ||||||||
| Practice Location | |||||||||
| Address1: | 2761 JEFFERSON DAVIS HWY STE 101 | ||||||||
| Address2: | |||||||||
| City: | STAFFORD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 225548330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9092814720 | ||||||||
| FaxNumber: | 9518085975 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2006 | ||||||||
| LastUpdateDate: | 01/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0101223707 | VA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 183878 | 01 | VA | ANTHEM | OTHER | 541595397 | 01 | VA | TRICARE | OTHER | 7516123 | 01 | VA | AETNA | OTHER | 541595397 | 01 | VA | VIRGINIA HEALTH NETWORK | OTHER | 27829 | 01 | VA | SENTARA/OPTIMA | OTHER | 010211689 | 05 | VA | MEDICAID |