Individual
DR. JARED WAYNE REAVES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10816 HICKORY RIDGE RD, COLUMBIA, MD 21044-3622
(877) 306-2217
Mailing address
6029 WATCH CHAIN WAY, COLUMBIA, MD 21044-4714
(877) 306-2217
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
0101249265
VA
208100000X
Physical Medicine & Rehabilitation Physician
Primary
D0074865
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
-017
TRICARE/CHAMPUS
VA
01
—
10078676
OPTIMA HEALTH
VA
01
—
1679754188
FIRST HEALTH NETWORK/COVENTRY HEALTH/SOUTHERN HEALTH
VA
05
—
1679754188
—
VA
01
—
438177
ANTHEM BC/BS
VA
05
—
5917488
—
NC
01
—
PAR
VIRGINIA HEALTH NETWORK
VA
Enumeration date
11/27/2007
Last updated
10/24/2023
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