Basic Information
| Provider Information | |||||||||
| NPI: | 1548327760 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REICHE | ||||||||
| FirstName: | DENNIS | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 601082 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282601082 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8648857989 | ||||||||
| FaxNumber: | 8648857867 | ||||||||
| Practice Location | |||||||||
| Address1: | 867 WHITWORTH CIR | ||||||||
| Address2: | |||||||||
| City: | SENECA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296729435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8648827400 | ||||||||
| FaxNumber: | 8648827401 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2007 | ||||||||
| LastUpdateDate: | 09/01/2009 | ||||||||
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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 | 207Q00000X | 1477 | SC | Y | Allopathic & Osteopathic Physicians | Family Medicine | 363LF0000X | 4704270788 | MI | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 1548327760 | 05 | SC | MEDICAID | P48193 | 01 | SC | MEDICARE PTAN | OTHER |