Basic Information
| Provider Information | |||||||||
| NPI: | 1659387439 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOCK | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | REYNOLDS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 308 S ACADEMY ST | ||||||||
| Address2: | |||||||||
| City: | LINCOLNTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280922717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7047369188 | ||||||||
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| Practice Location | |||||||||
| Address1: | 308 S ACADEMY ST | ||||||||
| Address2: | |||||||||
| City: | LINCOLNTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280922717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7047369188 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 05/09/2019 | ||||||||
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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 | 208M00000X | MD068240L | PA | Y | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 200101236 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | N01236 | 05 | SC | MEDICAID | 89129ON | 05 | NC | MEDICAID |