Healthcare Provider Details

I. General information

NPI: 1013911494
Provider Name (Legal Business Name): PAMELA JEAN REITNAUER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 03/07/2023
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N ELM ST
GREENSBORO NC
27401-1004
US

IV. Provider business mailing address

1200 N ELM ST
GREENSBORO NC
27401-1004
US

V. Phone/Fax

Practice location:
  • Phone: 336-832-8060
  • Fax: 336-832-7893
Mailing address:
  • Phone: 336-832-8060
  • Fax: 336-832-7893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number36251
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207SG0205X
TaxonomyPh.D. Medical Genetics Physician
License Number36251
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number36251
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: