Provider Demographics
NPI:1548215940
Name:REINOLD, KEVIN G (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:G
Last Name:REINOLD
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 1:1532 PARK AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:QUAKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18951-1048
Mailing Address - Country:US
Mailing Address - Phone:215-536-0655
Mailing Address - Fax:
Practice Address - Street 1:1532 PARK AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951-1048
Practice Address - Country:US
Practice Address - Phone:215-536-0655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD061289L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG30420Medicare UPIN