Individual
DR. KATHLEEN MARIE REARDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
101 E W T HARRIS BLVD, SUITE 1121, CHARLOTTE, NC 28262-3485
(704) 717-2000
(704) 863-9741
Mailing address
PO BOX 60099, CHARLOTTE, NC 28260-0099
(704) 717-2000
(704) 863-9741
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
28559
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
70711
BCBS
NC
05
—
7970711
—
NC
Enumeration date
07/13/2006
Last updated
05/29/2013
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