Provider Demographics
NPI:1659333433
Name:REID, CHARLES FREDRIC (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:FREDRIC
Last Name:REID
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 1:140 KIMEL PARK DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6946
Mailing Address - Country:US
Mailing Address - Phone:336-245-2100
Mailing Address - Fax:336-768-7782
Practice Address - Street 1:140 KIMEL PARK DR
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-6946
Practice Address - Country:US
Practice Address - Phone:336-245-2100
Practice Address - Fax:336-768-7782
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22963208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2344759OtherMEDICARE, GROUP
NC8971092Medicaid
NC340019145OtherRR MEDICARE
NC209867BOtherMEDICARE
NC2344759OtherMEDICARE, GROUP
NC209867CMedicare PIN