Healthcare Provider Details

I. General information

NPI: 1093539272
Provider Name (Legal Business Name): WILLIAM REEVES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S CATON AVE
BALTIMORE MD
21229-5201
US

IV. Provider business mailing address

1122 HOLY CROSS RD
STREET MD
21154-1116
US

V. Phone/Fax

Practice location:
  • Phone: 667-234-6000
  • Fax:
Mailing address:
  • Phone: 443-866-4452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0009709
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: