Provider Demographics
NPI:1457310690
Name:REED, MICHAEL ELMO (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ELMO
Last Name:REED
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 1:2480 TWO NOTCH RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-7963
Mailing Address - Country:US
Mailing Address - Phone:803-951-5871
Mailing Address - Fax:803-951-5872
Practice Address - Street 1:2480 TWO NOTCH RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-7963
Practice Address - Country:US
Practice Address - Phone:803-951-5871
Practice Address - Fax:803-951-5872
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8068207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC080682Medicaid
SC080682Medicaid
SCD178124950Medicare PIN