Provider Demographics
NPI:1245220573
Name:REITZ, ERIC DAVID (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:DAVID
Last Name:REITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 BRETTWOOD TRCE
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:NC
Mailing Address - Zip Code:28721-8021
Mailing Address - Country:US
Mailing Address - Phone:828-456-8633
Mailing Address - Fax:828-452-2792
Practice Address - Street 1:40 BRETTWOOD TRCE
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-8021
Practice Address - Country:US
Practice Address - Phone:828-456-8633
Practice Address - Fax:828-452-2792
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC94-00992208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8971211Medicaid
NC8971211Medicaid
NC2201513Medicare ID - Type Unspecified