1174597389 NPI number — DR. DEREK LAWRENCE REINKE M.D.

Table of content: DR. DEREK LAWRENCE REINKE M.D. (NPI 1174597389)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174597389 NPI number — DR. DEREK LAWRENCE REINKE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REINKE
Provider First Name:
DEREK
Provider Middle Name:
LAWRENCE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174597389
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 PERIMETER PARK DR STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORRISVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27560-8442
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1120 SE CARY PKWY
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
CARY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27511-7413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-467-4992
Provider Business Practice Location Address Fax Number:
919-232-5150
Provider Enumeration Date:
02/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207XX0005X , with the licence number:  9901000 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X , with the licence number: 9901000 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2350603 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2075594 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5544751 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 891217R , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1822991 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1217R . This is a "BCBS" identifier . This identifiers is of the category "OTHER".




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