Healthcare Provider Details

I. General information

NPI: 1972792109
Provider Name (Legal Business Name): CHARLES C REEL, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 10/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30065 BUSINESS CENTER DR STE 3
CHARLOTTE HALL MD
20622-3196
US

IV. Provider business mailing address

PO BOX 290
CHARLOTTE HALL MD
20622-0290
US

V. Phone/Fax

Practice location:
  • Phone: 410-742-1717
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARLES C REEL
Title or Position: CEO
Credential: MD
Phone: 410-742-1717