Provider Demographics
NPI:1710173018
Name:NEW, FRED REID JR (NP)
Entity Type:Individual
Prefix:MR
First Name:FRED
Middle Name:REID
Last Name:NEW
Suffix:JR
Gender:M
Credentials:NP
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Mailing Address - Street 1:140 GATEWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-5540
Mailing Address - Country:US
Mailing Address - Phone:704-664-9638
Mailing Address - Fax:704-664-1859
Practice Address - Street 1:140 GATEWAY BLVD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-5540
Practice Address - Country:US
Practice Address - Phone:704-664-9638
Practice Address - Fax:704-664-1859
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2023-08-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC0050-02175363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2594996Medicare PIN