Organization
PENINSULA ORTHOPAEDIC GROUP, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRUCE WALTER REID M.D. (PRESIDENT)
(757) 870-0699
Entity
Organization
Contact information
Practice address
304 MARCELLA RD, SUITE B, HAMPTON, VA 23666-2578
(757) 870-0699
Mailing address
304 MARCELLA RD, SUITE B, HAMPTON, VA 23666-2578
(757) 870-0699
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
0101036538
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ANTHEM
256737
VA
Enumeration date
10/02/2006
Last updated
08/24/2013
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