Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 2010-00377 | NC |
NPI | 1043264484 |
---|---|
Provider Name | Alden Reine JR. |
First Address | Charlotte, NC 28219-9305 |
Second Address | Lincolnton, NC 28092-4126 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2006 |
Last Update Date | 20/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G53574 | (02) | FL |