MEDICARE: DR. KATHLEEN MARIE REARDON 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	208000000X	Pediatrics Physician	28559	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	70711	OTHER	NC	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033134887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHLEEN MARIE REARDON MD

Provider Business Mailing Address
First Line	:	PO BOX 60099
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0099
Country	:	US
Telephone Number	:	704-717-2000
Fax Number	:	704-863-9741

Provider Business Practice Location Address
First Line	:	101 E W T HARRIS BLVD
Second Line	:	SUITE 1121
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-3485
Country	:	US
Telephone Number	:	704-717-2000
Fax Number	:	704-863-9741

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	05/29/2013

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