Provider Demographics
NPI:1174563704
Name:MATHIAS, REED A (MD)
Entity type:Individual
Prefix:
First Name:REED
Middle Name:A
Last Name:MATHIAS
Suffix:
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 25039
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29616-0039
Mailing Address - Country:US
Mailing Address - Phone:864-365-0200
Mailing Address - Fax:864-365-0205
Practice Address - Street 1:10 ENTERPRISE BLVD. STE 111
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3534
Practice Address - Country:US
Practice Address - Phone:864-365-0200
Practice Address - Fax:864-365-0205
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23959208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC239593Medicaid
I34739Medicare UPIN
SC239593Medicaid
SCAA09728165Medicare ID - Type Unspecified
SCAA4350Medicare PIN