Organization
REARDEN INTERNAL MEDICINE & GERIATRICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GAIL LASHUN REARDEN M.D. (OWNER)
(843) 277-2771
Entity
Organization
Contact information
Practice address
1205 WISTERIA RD, CHARLESTON, SC 29407-5226
(843) 277-2771
(843) 277-2778
Mailing address
P O BOX 2191, WALTERBORO, SC 29488-3933
(843) 277-2771
(843) 277-2778
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
302586
—
SC
01
—
42D2052192
CLAI WAIVER
SC
01
—
42D2093779
CLIA WAIVER
SC
Enumeration date
02/23/2010
Last updated
05/24/2015
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