Basic Information
| Provider Information | |||||||||
| NPI: | 1588607253 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REID | ||||||||
| FirstName: | DORIS | ||||||||
| MiddleName: | ANNETTE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | VA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3700 FETTLER PARK | ||||||||
| Address2: | DUMFRIES HEALTH CENTER | ||||||||
| City: | DUMFRIES | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7034417500 | ||||||||
| FaxNumber: | 8043787858 | ||||||||
| Practice Location | |||||||||
| Address1: | 3700 FETTLER PARK | ||||||||
| Address2: | DUMFRIES HEALTH CENTER | ||||||||
| City: | DUMFRIES | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7034417500 | ||||||||
| FaxNumber: | 8043787858 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2006 | ||||||||
| LastUpdateDate: | 04/03/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0101041970 | VA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 56-3312-5 | 05 | VA | MEDICAID | 333612 | 01 | VA | ANTHEM | OTHER |