Provider Demographics
NPI:1568677920
Name:REYNOLDS, ERICA BRONWEN (MD)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:BRONWEN
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:102 HIGHLAND AVE SE STE 455
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24013-2202
Mailing Address - Country:US
Mailing Address - Phone:540-224-4445
Mailing Address - Fax:540-342-0253
Practice Address - Street 1:4348 ELECTRIC RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-0720
Practice Address - Country:US
Practice Address - Phone:540-769-0976
Practice Address - Fax:540-857-5386
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2021-11-02
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Provider Licenses
StateLicense IDTaxonomies
VA0101249767208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC41032BMedicare UPIN