Healthcare Provider Details

I. General information

NPI: 1134175227
Provider Name (Legal Business Name): VIRGINIA REED KILLOREN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VIRGINIA ELIZABETH REED M.D.

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 12/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1332 SEA MIST DR
MATTHEWS NC
28105
US

IV. Provider business mailing address

1332 SEA MIST DR
MATTHEWS NC
28105-6640
US

V. Phone/Fax

Practice location:
  • Phone: 803-514-3812
  • Fax:
Mailing address:
  • Phone: 803-514-3812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberM0131
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2016-02211
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: