MEDICARE: DAVID W. REID, M.D., P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	0904000493	VA

General Provider Information

NPI Number	:	1700150422
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID W. REID, M.D., P.C.

Provider Business Mailing Address
First Line	:	1060 LASKIN RD
Second Line	:	UNIT 11B
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-6365
Country	:	US
Telephone Number	:	757-456-0505
Fax Number	:	757-456-0817

Provider Business Practice Location Address
First Line	:	1060 LASKIN RD
Second Line	:	UNIT 11B
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-6365
Country	:	US
Telephone Number	:	757-456-0505
Fax Number	:	757-456-0817

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MISS REBECCA DEAN REID
Credential	:	L.C.S.W.
Telephone Number	:	757-456-0505

Provider Enumeration Date	:	02/27/2012
Last Update Date	:	02/27/2012

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