Provider Demographics
NPI:1467528687
Name:REYNOLDS, LEONARD A (DPM)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:A
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 454
Mailing Address - Street 2:
Mailing Address - City:WELLSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26070-0454
Mailing Address - Country:US
Mailing Address - Phone:304-233-0630
Mailing Address - Fax:304-233-0632
Practice Address - Street 1:53 14TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3433
Practice Address - Country:US
Practice Address - Phone:304-233-0630
Practice Address - Fax:304-233-0632
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV0271213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0099792000Medicaid
WV480026065OtherRAILROAD MEDICARE
OH0117911Medicaid
WV0733467Medicare PIN
WVU39766Medicare UPIN
OH0117911Medicaid
WV0099792000Medicaid