Provider Demographics
NPI:1144206194
Name:REYNOLDS, DAVID N (MD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:N
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:124 OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-9606
Mailing Address - Country:US
Mailing Address - Phone:434-295-8217
Mailing Address - Fax:
Practice Address - Street 1:1522 INSURANCE LN
Practice Address - Street 2:SUITE A
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-7229
Practice Address - Country:US
Practice Address - Phone:434-974-9600
Practice Address - Fax:434-296-1036
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101038384208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA267088OtherMAMSI/ALLIANCE
VA52443OtherVETRI
VA12062600002OtherSOUTHERN HEALTH
VA010722OtherCIGNA
VA333842OtherANTHEM