Basic Information
| Provider Information | |||||||||
| NPI: | 1326151010 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | REED DERMATOLOGY CLINIC PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1870 N CENTER ST | ||||||||
| Address2: | |||||||||
| City: | HICKORY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286011853 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283227546 | ||||||||
| FaxNumber: | 8283229927 | ||||||||
| Practice Location | |||||||||
| Address1: | 1870 N CENTER ST | ||||||||
| Address2: | |||||||||
| City: | HICKORY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286011853 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283227546 | ||||||||
| FaxNumber: | 8283229927 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2006 | ||||||||
| LastUpdateDate: | 08/17/2010 | ||||||||
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| AuthorizedOfficialLastName: | REED | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
| AuthorizedOfficialMiddleName: | N | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8283227546 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 24612 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 012F6 | 01 | NC | BCBS OF NORTH CAROLINA | OTHER | 8970788 | 05 | NC | MEDICAID |