Provider Demographics
NPI:1972587657
Name:REIS, GRETCHEN ANN (MD)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:ANN
Last Name:REIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2550 W ARROWOOD RD STE 106
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-6658
Mailing Address - Country:US
Mailing Address - Phone:704-220-1770
Mailing Address - Fax:704-886-1883
Practice Address - Street 1:2550 W ARROWOOD RD STE 106
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273
Practice Address - Country:US
Practice Address - Phone:704-220-1770
Practice Address - Fax:336-419-4546
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35086750207Q00000X
NC2013-00747207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F87584Medicare UPIN