Provider Demographics
NPI:1326227380
Name:LEONARD A. REYNOLDS, DPM
Entity Type:Organization
Organization Name:LEONARD A. REYNOLDS, DPM
Other - Org Name:FAMILY FOOT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:304-233-0630
Mailing Address - Street 1:PO BOX 2102
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-0222
Mailing Address - Country:US
Mailing Address - Phone:304-233-0630
Mailing Address - Fax:304-233-0632
Practice Address - Street 1:1025 MAIN ST
Practice Address - Street 2:SUITE 602
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-2726
Practice Address - Country:US
Practice Address - Phone:304-233-0630
Practice Address - Fax:304-233-0632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV0271213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001710768OtherMOUNTAIN STATE BC/BS
WVSP04841Medicare PIN
WVSP04842Medicare PIN