Provider Demographics
NPI:1114923364
Name:REYNOLDS, DAVID R (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:REYNOLDS
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 1:280 CHESTNUT ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199-1001
Mailing Address - Country:US
Mailing Address - Phone:413-794-5700
Mailing Address - Fax:
Practice Address - Street 1:83 SOUTH ST
Practice Address - Street 2:
Practice Address - City:WARE
Practice Address - State:MA
Practice Address - Zip Code:01082-1660
Practice Address - Country:US
Practice Address - Phone:413-967-2800
Practice Address - Fax:413-967-2806
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA73549208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT735490OtherCONNECTICAIRE
MA765232OtherTUFTS
MAJ16012OtherBCBS
MA801159OtherHARVARD PILGRIM
MA0021518OtherNEIGHBORHOOD HEALTH
J16012Medicare ID - Type Unspecified
MA115879OtherHNE
MAF88198Medicare UPIN
MA3135241Medicaid