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NPI Code Detail

MEDICARE: DR. TERRY J REARDON

MEDICARE: DR. TERRY J REARDON
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
1207R00000XInternal Medicine PhysicianL022746LA
2207R00000XInternal Medicine Physician21368SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1518961028
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TERRY J REARDON
Provider Business Mailing Address
First Line : 64 BUSINESS CENTER DR
Second Line :
City : PAWLEYS ISLAND
State : SC
Zip : 29585-7963
Country : US
Telephone Number : 843-314-1314
Fax Number : 843-314-1308
Provider Business Practice Location Address
First Line : 64 BUSINESS CENTER DR
Second Line :
City : PAWLEYS ISLAND
State : SC
Zip : 29585-7963
Country : US
Telephone Number : 843-314-1314
Fax Number : 843-314-1306
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2005
Last Update Date : 03/07/2023

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