Provider Demographics
NPI:1760423594
Name:REEG, SCOT ERIC (MD)
Entity Type:Individual
Prefix:
First Name:SCOT
Middle Name:ERIC
Last Name:REEG
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:PO BOX 63362
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28263-3362
Mailing Address - Country:US
Mailing Address - Phone:800-782-6945
Mailing Address - Fax:
Practice Address - Street 1:1565 ORCHARD VILLAS AVE
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-4321
Practice Address - Country:US
Practice Address - Phone:919-367-9355
Practice Address - Fax:919-367-9276
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36586207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8970841Medicaid
NC70841OtherBCBS
92348OtherMEDCOST
92348OtherMEDCOST
NC8970841Medicaid