Healthcare Provider Details

I. General information

NPI: 1104801935
Provider Name (Legal Business Name): WILLIAM CLARK REED JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 09/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 SKIPWITH RD
RICHMOND VA
23229
US

IV. Provider business mailing address

4050 INNSLAKE DR SUITE 308
GLEN ALLEN VA
23060-3327
US

V. Phone/Fax

Practice location:
  • Phone: 804-288-0399
  • Fax:
Mailing address:
  • Phone: 804-521-5315
  • Fax: 804-521-5312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101234551
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: