Basic Information
| Provider Information | |||||||||
| NPI: | 1184818890 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REAVILL | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | SCOTT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 4402 SHIPYARD BLVD | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284036161 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102023363 | ||||||||
| FaxNumber: | 9103321072 | ||||||||
| Practice Location | |||||||||
| Address1: | 4402 SHIPYARD BLVD | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284036161 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102023363 | ||||||||
| FaxNumber: | 9103321072 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2007 | ||||||||
| LastUpdateDate: | 05/11/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0004X | 4301086188 | MI | N | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services | 207P00000X | 32415 | SC | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 201402245 | NC | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 32415 | 01 | SC | LICENSE | OTHER | 2014-02245 | 01 | NC | NC LICENSE | OTHER |