Provider Demographics
NPI:1508814971
Name:REYNOLDS, JAMES WEBSTER (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:WEBSTER
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 1:129 RODNEY CIR
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3727
Mailing Address - Country:US
Mailing Address - Phone:610-527-4580
Mailing Address - Fax:
Practice Address - Street 1:251 E BRINGHURST ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-1719
Practice Address - Country:US
Practice Address - Phone:215-844-1020
Practice Address - Fax:215-844-2702
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD024923-E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008833100035Medicaid
PA103844Medicare ID - Type Unspecified
PA0008833100035Medicaid