Active NPI
Kathleen Marie Reardon, MD
- Pediatrics Physician
- Charlotte, NC
National Provider Identifier
1033134887
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 28559
- Practice address
- 101 E W T Harris Blvd
Suite 1121
Charlotte, NC 28262-3485 - Phone
- (704) 717-2000
- Fax
- (704) 863-9741
- NPI assigned
- Jul 13, 2006
- Last updated
- May 29, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 28559 | NC | Primary |
Addresses
Primary practice location
101 E W T Harris Blvd
Suite 1121
Charlotte, NC 28262-3485
Mailing address
PO Box 60099
Charlotte, NC 28260-0099
Phone (704) 717-2000
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 70711 | Other | NC | BCBS |
| 7970711 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28559 | NC | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University Pediatrics | Pediatrics | Past | Accepting new patients |
| University Pediatrics | Pediatrics | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Atrium Health Levine Children's University Pediatrics
- Pediatrics Physician
- Charlotte, NC
- NPI 1073541124
-
- Pediatrics Physician
- Mint Hill, NC
- NPI 1609102649
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152748800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1369785600000",
"number": "1033134887",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 60099",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282600099",
"telephone_number": "704-717-2000",
"fax_number": "704-863-9741"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 E W T HARRIS BLVD",
"address_2": "SUITE 1121",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282623485",
"telephone_number": "704-717-2000",
"fax_number": "704-863-9741"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REARDON",
"first_name": "KATHLEEN",
"middle_name": "MARIE",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-13",
"last_updated": "2013-05-29",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NC",
"license": "28559",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "70711",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7970711",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.