Healthcare Provider Details

I. General information

NPI: 1851088587
Provider Name (Legal Business Name): MATTHEW REESE LAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2023
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 ALLEN ST STE 101
RUTLAND VT
05701-4570
US

IV. Provider business mailing address

71 ALLEN ST STE 101
RUTLAND VT
05701-4570
US

V. Phone/Fax

Practice location:
  • Phone: 802-779-9036
  • Fax:
Mailing address:
  • Phone: 802-779-9036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number042.0019311
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: