Healthcare Provider Details

I. General information

NPI: 1003887787
Provider Name (Legal Business Name): HAROLD R REEVE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

668 MAIN ST STE 4
LUMBERTON NJ
08048
US

IV. Provider business mailing address

668 MAIN ST STE 4
LUMBERTON NJ
08048
US

V. Phone/Fax

Practice location:
  • Phone: 609-267-6800
  • Fax: 609-267-8932
Mailing address:
  • Phone: 609-267-6800
  • Fax: 609-267-8932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD067331L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number25MA03602100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: