Provider Demographics
NPI:1336231299
Name:GRINE, REYNOLD CARTER (MD)
Entity type:Individual
Prefix:MR
First Name:REYNOLD
Middle Name:CARTER
Last Name:GRINE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:185 PAGE ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8747
Mailing Address - Country:US
Mailing Address - Phone:910-295-5567
Mailing Address - Fax:910-295-3315
Practice Address - Street 1:185 PAGE ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8747
Practice Address - Country:US
Practice Address - Phone:910-295-5567
Practice Address - Fax:910-295-3315
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2020-03-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC200001918519207N00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1034POtherBLUE CROSS
NC8902423Medicaid
NC891034PMedicaid
NCG47987Medicare UPIN
NC8902423Medicaid