Provider Demographics
NPI:1619973773
Name:REEL, CHARLES C (MD)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:C
Last Name:REEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 290
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE HALL
Mailing Address - State:MD
Mailing Address - Zip Code:20622-0290
Mailing Address - Country:US
Mailing Address - Phone:301-290-0395
Mailing Address - Fax:301-290-0396
Practice Address - Street 1:30065 BUSINESS CENTER DRIVE
Practice Address - Street 2:UNIT 3
Practice Address - City:CHARLOTTE HALL
Practice Address - State:MD
Practice Address - Zip Code:20622
Practice Address - Country:US
Practice Address - Phone:301-290-0395
Practice Address - Fax:301-290-0396
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00446972084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD985LMedicare PIN
MDF60978Medicare UPIN