Healthcare Provider Details

I. General information

NPI: 1861135683
Provider Name (Legal Business Name): OSCAR ROLANDO REYES JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 07/03/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VCUHS DEPT OF MED-PEDS RESIDENCY 417 N 11TH ST
RICHMOND VA
23298
US

IV. Provider business mailing address

VCUHS GMEA BOX 980257
RICHMOND VA
23298-0257
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-6685
  • Fax: 804-827-0503
Mailing address:
  • Phone: 804-828-9783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0116036971
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: