Basic Information
| Provider Information | |||||||||
| NPI: | 1447246566 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REICH | ||||||||
| FirstName: | PATIENCE | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | AGBORBESONG | ||||||||
| OtherFirstName: | PATIENCE | ||||||||
| OtherMiddleName: | R | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 60447 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282600447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3364743444 | ||||||||
| FaxNumber: | 3364748111 | ||||||||
| Practice Location | |||||||||
| Address1: | 207 OLD LEXINGTON RD | ||||||||
| Address2: | |||||||||
| City: | THOMASVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273603428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3364743444 | ||||||||
| FaxNumber: | 3364748111 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2005 | ||||||||
| LastUpdateDate: | 10/25/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 09/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 20000-1049 | NC | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 200001049 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | D4333 | 01 | MEDCOST | OTHER | 89136T7 | 05 | NC | MEDICAID | Q01049 | 05 | SC | MEDICAID | 10082170 | 05 | VA | MEDICAID | 7135167 | 01 | AETNA | OTHER | 136T7 | 01 | BCBS | OTHER | 3810000417 | 05 | WV | MEDICAID | 38513 | 01 | PARTNERS | OTHER |