Provider Demographics
NPI:1003829474
Name:REYNOLDS, DAVID DEWITT (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:DEWITT
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1860 FAIR AVE.
Mailing Address - Street 2:SUITE A
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-1032
Mailing Address - Country:US
Mailing Address - Phone:570-253-3391
Mailing Address - Fax:570-253-1811
Practice Address - Street 1:1860 FAIR AVE.
Practice Address - Street 2:SUITE A
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-1032
Practice Address - Country:US
Practice Address - Phone:570-253-3391
Practice Address - Fax:570-253-1811
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD043252L207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA110163810OtherMEDICARE RAILROAD
PARE725073OtherBLUE SHIELD
PA0012880140006Medicaid
PA2400390OtherGHI
PA9036990OtherPHCS
PA0562453000OtherAMERIHEALTH
PA804628OtherFIRST PRIORITY
PA2400390OtherGHI