Provider Demographics
NPI:1386607349
Name:REINHARDT, RICHARD BENNETT JR (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:BENNETT
Last Name:REINHARDT
Suffix:JR
Gender:M
Credentials:MD
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 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:1330 BOILING SPRINGS RD STE 2300
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303
Practice Address - Country:US
Practice Address - Phone:864-585-6491
Practice Address - Fax:864-585-1368
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18910208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC189102Medicaid
SCH167107628OtherMEDICARE PIN
SC53983OtherMEDCOST
NC89064FRMedicaid
SC7984239OtherAETNA
SC53983OtherMEDCOST
SCH16710Medicare PIN