Provider Demographics
NPI:1306814173
Name:REED, PAULINE CARVELLA (MD)
Entity type:Individual
Prefix:DR
First Name:PAULINE
Middle Name:CARVELLA
Last Name:REED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 GENERAL BOOTH BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-4857
Mailing Address - Country:US
Mailing Address - Phone:757-425-3610
Mailing Address - Fax:757-422-3714
Practice Address - Street 1:940 GENERAL BOOTH BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-4857
Practice Address - Country:US
Practice Address - Phone:757-425-3610
Practice Address - Fax:757-422-3714
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101102766207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005624657Medicaid
080007785Medicare ID - Type Unspecified
VA005624657Medicaid