Provider Demographics
NPI:1184121006
Name:LIVINGSTON, REGINALD
Entity type:Individual
Prefix:
First Name:REGINALD
Middle Name:
Last Name:LIVINGSTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4530 HARGROVE RD APT 105
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-2868
Mailing Address - Country:US
Mailing Address - Phone:919-802-8364
Mailing Address - Fax:
Practice Address - Street 1:4530 HARGROVE RD APT 105
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-2868
Practice Address - Country:US
Practice Address - Phone:919-802-8364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-08
Last Update Date:2018-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health