Provider Demographics
NPI:1215034657
Name:REYNOLDS, LINDA M (BS, RDCS, RCVT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:M
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:BS, RDCS, RCVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 PLANK RD # 358
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-6888
Mailing Address - Country:US
Mailing Address - Phone:540-786-0383
Mailing Address - Fax:540-786-0383
Practice Address - Street 1:3601 PLANK RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-6888
Practice Address - Country:US
Practice Address - Phone:540-786-0383
Practice Address - Fax:540-786-0383
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA246XS1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA268067OtherMDIPA/OPT CHOICE PROV #
VA223780OtherANTHEM BC/BS PROVIDER #
VA268067OtherALLIANCE PROV #
VA470000692OtherRAILROAD MEDICARE PROV #
VA268067OtherMAMSI PROVIDER NUMBER
VA4991273OtherVA PREMIER PROVIDER #
VA4991273Medicaid
VAFVC001Medicare ID - Type UnspecifiedPROVIDER NUMBER