Provider Demographics
NPI:1740889203
Name:REIGEL, ANNA SUCCOP (PA-C)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:SUCCOP
Last Name:REIGEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13207 CAITE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-0450
Mailing Address - Country:US
Mailing Address - Phone:704-737-1945
Mailing Address - Fax:
Practice Address - Street 1:5950 FAIRVIEW RD STE 808
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-2110
Practice Address - Country:US
Practice Address - Phone:980-867-4440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-25
Last Update Date:2022-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-10293363AM0700X
NC363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical