Provider Demographics
NPI:1578596763
Name:REING, CORNELIUS MICHAEL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CORNELIUS
Middle Name:MICHAEL
Last Name:REING
Suffix:JR
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 1:112 MONTHOMERY DRIVE
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621
Mailing Address - Country:US
Mailing Address - Phone:864-276-0056
Mailing Address - Fax:864-231-2872
Practice Address - Street 1:112 MONTHOMERY DRIVE
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621
Practice Address - Country:US
Practice Address - Phone:864-276-0056
Practice Address - Fax:864-231-2872
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101030631174400000X
SC33035207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC330350Medicaid
SCP00973427OtherRR MEDICARE
SC7111Medicare PIN
SCP00973427OtherRR MEDICARE
VAB94488Medicare UPIN