MEDICARE: PAMELA CRUZ REISER M.D.

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	207Q00000X	Family Medicine Physician	0101262278	VA

General Provider Information

NPI Number	:	1952720690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA CRUZ REISER M.D.

Provider Business Mailing Address
First Line	:	701 S MAIN ST
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23523-1245
Country	:	US
Telephone Number	:	757-388-1830
Fax Number	:	855-939-7176

Provider Business Practice Location Address
First Line	:	701 S MAIN ST
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23523-1245
Country	:	US
Telephone Number	:	757-388-1830
Fax Number	:	855-939-7176

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2014
Last Update Date	:	06/20/2025

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