Provider Demographics
NPI:1073532362
Name:REINHOLD, RANDOLPH B (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDOLPH
Middle Name:B
Last Name:REINHOLD
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 1:330 ORCHARD ST.
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511
Mailing Address - Country:US
Mailing Address - Phone:203-789-3152
Mailing Address - Fax:203-867-5457
Practice Address - Street 1:330 ORCHARD ST.
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511
Practice Address - Country:US
Practice Address - Phone:203-789-3152
Practice Address - Fax:203-867-5457
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT032595208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00374172Medicare PIN
A35426Medicare UPIN
CT020001683Medicare PIN