Provider Demographics
NPI:1659387439
Name:LOCK, RICHARD REYNOLDS (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:REYNOLDS
Last Name:LOCK
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 1:308 S ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-2717
Mailing Address - Country:US
Mailing Address - Phone:704-736-9188
Mailing Address - Fax:
Practice Address - Street 1:308 S ACADEMY ST
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-2717
Practice Address - Country:US
Practice Address - Phone:704-736-9188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD068240L208M00000X
NC200101236207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN01236Medicaid
NC89129ONMedicaid
NCG29186Medicare UPIN
SCN01236Medicaid