Basic Information
| Provider Information | |||||||||
| NPI: | 1730158858 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REULBACH | ||||||||
| FirstName: | TODD | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6035 FAIRVIEW RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282103256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042953000 | ||||||||
| FaxNumber: | 7042953468 | ||||||||
| Practice Location | |||||||||
| Address1: | 10305 HAMPTONS PARK DRIVE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | HUNTERSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280787217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042953600 | ||||||||
| FaxNumber: | 7048923181 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2006 | ||||||||
| LastUpdateDate: | 04/26/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 9701561 | NC | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 000000297877 | 01 | SC | UNISON HEALTH PLAN OF SC | OTHER | 134K5 | 01 | NC | BCBS | OTHER | 20097009 | 01 | SC | SELECT HEALTH OF SC | OTHER | N01561 | 05 | SC | MEDICAID | P00026764 | 01 | NC | RAILROAD MEDICARE | OTHER | 89134K5 | 05 | NC | MEDICAID |