Healthcare Provider Details

I. General information

NPI: 1750176459
Provider Name (Legal Business Name): THOMAS C REESE JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2025
Last Update Date: 04/12/2025
Certification Date: 04/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

814 ALMOND AVE
NORFOLK VA
23502-4302
US

IV. Provider business mailing address

814 ALMOND AVE
NORFOLK VA
23502-4302
US

V. Phone/Fax

Practice location:
  • Phone: 860-818-6314
  • Fax:
Mailing address:
  • Phone: 860-818-6314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberA61670951
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: