Provider Demographics
NPI:1093917841
Name:JOSEPH, REENA SINI (MD)
Entity Type:Individual
Prefix:
First Name:REENA
Middle Name:SINI
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:REENA
Other - Middle Name:ALEYAMMA
Other - Last Name:JOHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2701 MEDICAL OFFICE PL
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-9458
Mailing Address - Country:US
Mailing Address - Phone:919-739-8680
Mailing Address - Fax:919-739-8616
Practice Address - Street 1:2701 MEDICAL OFFICE PL
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9458
Practice Address - Country:US
Practice Address - Phone:919-739-8680
Practice Address - Fax:919-739-8616
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-01990207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5911202Medicaid
NC1517POtherBCBS OF NC
NC2023317Medicare PIN