Provider Demographics
NPI:1457319543
Name:REYNOLDS, MICHAEL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
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 1:4821 MONTGOMERY LN
Mailing Address - Street 2:801
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-3471
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4821 MONTGOMERY LN
Practice Address - Street 2:801
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3471
Practice Address - Country:US
Practice Address - Phone:301-633-2801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31497207L00000X
DCMD041534207L00000X, 207LH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LH0002XAllopathic & Osteopathic PhysiciansAnesthesiologyHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD197543H41Medicare PIN