Provider Demographics
NPI:1245568963
Name:MARL E REYNOLDS MD INC
Entity Type:Organization
Organization Name:MARL E REYNOLDS MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-848-9858
Mailing Address - Street 1:4301 STATE ROUTE 725
Mailing Address - Street 2:STE B
Mailing Address - City:BELLBROOK
Mailing Address - State:OH
Mailing Address - Zip Code:45305-1552
Mailing Address - Country:US
Mailing Address - Phone:937-848-9858
Mailing Address - Fax:937-848-2080
Practice Address - Street 1:4301 STATE ROUTE 725
Practice Address - Street 2:STE B
Practice Address - City:BELLBROOK
Practice Address - State:OH
Practice Address - Zip Code:45305-1552
Practice Address - Country:US
Practice Address - Phone:937-848-9858
Practice Address - Fax:937-848-2080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-19
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH614864600OtherFEDERAL WORKER'S COMP