Individual
MICHAEL L REARDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
906 WB MCLEAN BLVD, CAPE CARTERET, NC 28584-9211
(252) 393-9007
(252) 393-9921
Mailing address
PO BOX 896206, CHARLOTTE, NC 28289-6206
(252) 633-1010
(252) 224-3071
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
9801035
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10590
BLUE CROSS
NC
01
—
2259079B
MEDICARE PTAN
NC
05
—
8910590
—
NC
Enumeration date
08/23/2005
Last updated
03/17/2017
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