Provider Demographics
NPI:1174597389
Name:REINKE, DEREK LAWRENCE (MD)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:LAWRENCE
Last Name:REINKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2000 PERIMETER PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-8442
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1120 SE CARY PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-7413
Practice Address - Country:US
Practice Address - Phone:919-467-4992
Practice Address - Fax:919-232-5150
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9901000207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2350603OtherAETNA HMO
2075594OtherFIRST HEALTH
5544751OtherAETNA PPO
NC891217RMedicaid
1822991OtherUNITED HEALTHCARE
1217ROtherBCBS
2276845Medicare ID - Type Unspecified
5544751OtherAETNA PPO