Provider Demographics
NPI:1922098490
Name:REESE, MITCHELL C (MD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:C
Last Name:REESE
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 1:1801 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-5067
Mailing Address - Country:US
Mailing Address - Phone:919-774-7117
Mailing Address - Fax:919-776-6715
Practice Address - Street 1:1801 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-5067
Practice Address - Country:US
Practice Address - Phone:919-774-7117
Practice Address - Fax:919-776-6715
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC230772080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC23077OtherMEDICAL LICENSE NUMBER
NCE20984Medicare UPIN