MEDICARE: DR. GAIL L REARDEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	TL30258	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00450327	OTHER	SC	RAILROAD MEDICARE
3	CF9180	OTHER	SC	GRP RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	P0079628	OTHER	SC	RAILROAD MC ID-RSFPN

General Provider Information

NPI Number	:	1568582906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GAIL L REARDEN MD

Provider Business Mailing Address
First Line	:	PO BOX 740013
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-0013
Country	:	US
Telephone Number	:	312-733-9730
Fax Number	:	773-866-8014

Provider Business Practice Location Address
First Line	:	550 S CHURCH ST STE 4
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29306-3306
Country	:	US
Telephone Number	:	864-774-7001
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	07/11/2023

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Directions to “ DR. GAIL L REARDEN MD” Practice Location

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