Provider Demographics
NPI:1952336612
Name:REID, ALAN J (PA)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:J
Last Name:REID
Suffix:
Gender:M
Credentials:PA
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 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14214 BALLANTYNE LAKE RD
Practice Address - Street 2:STE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-3372
Practice Address - Country:US
Practice Address - Phone:704-667-2650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101433363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2624PAMedicaid
NC1952336612Medicaid
NC8102086Medicaid
NCNC3812BMedicare PIN
NCNC3812AMedicare PIN
NCNC3812KMedicare PIN
NC1952336612Medicaid
NCNC3812OMedicare PIN
NCNC3812CMedicare PIN
NCR18930Medicare UPIN
NCNC3812JMedicare PIN
NCNC3812MMedicare PIN
NC2748762CMedicare PIN
NCNC3812EMedicare PIN
SC2624PAMedicaid
NCNC3812HMedicare PIN
NCNC3812NMedicare UPIN
NC8102086Medicaid
NCNC3812GMedicare PIN
NC2748762Medicare PIN