Healthcare Provider Details

I. General information

NPI: 1174619522
Provider Name (Legal Business Name): DAVID EARL REAGIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 SOUTHERN AVE SE
WASHINGTON DC
20032-4623
US

IV. Provider business mailing address

3604 SOUTH PL
ALEXANDRIA VA
22309-2201
US

V. Phone/Fax

Practice location:
  • Phone: 202-574-6554
  • Fax: 202-279-7329
Mailing address:
  • Phone: 703-780-9328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberMD8494
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD8494
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: