MEDICARE: CAROLINA UROLOGY HEALTHCARE, PLLC

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	208800000X	Urology Physician	200300399	NC

Other Identifiers

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

General Provider Information

NPI Number	:	1598997371
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA UROLOGY HEALTHCARE, PLLC

Provider Business Mailing Address
First Line	:	1021 BEAMAN STREET
Second Line	:
City	:	CLINTON
State	:	NC
Zip	:	28328-4001
Country	:	US
Telephone Number	:	910-590-3569
Fax Number	:	910-592-3525

Provider Business Practice Location Address
First Line	:	1021 BEAMAN STREET
Second Line	:
City	:	CLINTON
State	:	NC
Zip	:	28328-4001
Country	:	US
Telephone Number	:	910-590-3569
Fax Number	:	910-592-3525

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	DR. ROBERT WILLIAM REAGAN JR.
Credential	:	MD
Telephone Number	:	910-590-3569

Provider Enumeration Date	:	08/13/2009
Last Update Date	:	07/17/2020

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