Provider Demographics
NPI:1104822386
Name:REYNOLDS, MICHAEL K (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:K
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:514 W ATLANTIC ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HILL
Mailing Address - State:VA
Mailing Address - Zip Code:23970-1906
Mailing Address - Country:US
Mailing Address - Phone:434-447-6969
Mailing Address - Fax:434-447-2240
Practice Address - Street 1:8380 BOYDTON PLANK RD
Practice Address - Street 2:
Practice Address - City:ALBERTA
Practice Address - State:VA
Practice Address - Zip Code:23821-2851
Practice Address - Country:US
Practice Address - Phone:434-949-7211
Practice Address - Fax:434-447-2240
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101236563207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA189199OtherBCBS #
VA51558OtherCARENET
VA010091098OtherVA PREMIER
VA010091101Medicaid
VA1104822386Medicaid
VA224189800OtherDOL
VA5902981OtherNC MEDICAID
VA144581OtherBCBS #
VA3536927OtherCIGNA
VA4583985OtherAETNA
VA90188OtherOPTIMA
VA299420OtherSOUTHERN HEALTH
VAP00227639OtherSH RR MEDICARE
VA010091098Medicaid
VA010103371Medicaid
VA144592OtherBCBS #
VAD9941OtherMEDCOST
VA1104822386OtherNPI
VA493833Medicare Oscar/Certification
VA1104822386Medicare PIN
VA144581OtherBCBS #
VA144592OtherBCBS #
VA1104822386Medicaid
VA493869Medicare Oscar/Certification