Individual
REGINALD F. MUNDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., D.M.D.
Contact information
Practice address
171 ASHLEY AVE, CHARLESTON, SC 29425-0001
(843) 792-1414
Mailing address
PO BOX 751461, CHARLOTTE, NC 28275-1461
(843) 792-6200
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
28666
AL
2085R0202X
Diagnostic Radiology Physician
Primary
15486
SC
2085R0202X
Diagnostic Radiology Physician
2016-02125
NC
2085R0202X
Diagnostic Radiology Physician
J8328
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009914016
—
AL
05
—
009914017
—
AL
05
—
009914018
—
AL
05
—
009914019
—
AL
05
—
009914021
—
AL
01
—
051546435
BCBS OF AL
AL
01
—
051546437
BCBS OF AL
AL
01
—
051546438
BCBS OF AL
AL
01
—
051546439
BCBS OF AL
AL
01
—
051546440
BCBS OF AL
AL
01
—
G04973
VIVA
AL
Enumeration date
09/15/2006
Last updated
03/16/2021
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