Healthcare Provider Details

I. General information

NPI: 1417693003
Provider Name (Legal Business Name): REAGAN DENISE MONTEITH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2022
Last Update Date: 12/08/2022
Certification Date: 12/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10401 HOSPITAL DR STE 101
CLINTON MD
20735-3150
US

IV. Provider business mailing address

10401 HOSPITAL DR STE 101
CLINTON MD
20735-3150
US

V. Phone/Fax

Practice location:
  • Phone: 301-856-2323
  • Fax:
Mailing address:
  • Phone: 301-856-2323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110008506
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC08432
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: