Provider Demographics
NPI:1114548492
Name:REID, KEVIN CHRISTOPHER (PA)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:CHRISTOPHER
Last Name:REID
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:14995 SHADY GROVE RD STE 350
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-8726
Mailing Address - Country:US
Mailing Address - Phone:301-251-1433
Mailing Address - Fax:301-424-5266
Practice Address - Street 1:2296 OPITZ BLVD STE 350
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3346
Practice Address - Country:US
Practice Address - Phone:703-680-2111
Practice Address - Fax:703-878-3939
Is Sole Proprietor?:No
Enumeration Date:2020-04-28
Last Update Date:2025-01-15
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Provider Licenses
StateLicense IDTaxonomies
MDC07941363A00000X
363A00000X
VA0110007679363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant