Provider Demographics
NPI:1609954999
Name:MCREYNOLDS & ASSOCIATES
Entity Type:Organization
Organization Name:MCREYNOLDS & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:MCREYNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-994-8860
Mailing Address - Street 1:5515 KIRKWOOD MILLTOWN PLAZA
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808
Mailing Address - Country:US
Mailing Address - Phone:302-995-7181
Mailing Address - Fax:302-995-7186
Practice Address - Street 1:5515 KIRKWOOD MILLTOWN PLAZA
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808
Practice Address - Country:US
Practice Address - Phone:302-995-7181
Practice Address - Fax:302-995-7186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10000828208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000077102Medicaid
DE0000077102Medicaid