Provider Demographics
NPI:1720003015
Name:GOLDEN, REYNOLD S (MD)
Entity Type:Individual
Prefix:
First Name:REYNOLD
Middle Name:S
Last Name:GOLDEN
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 1:105 CANAL LANDING BLVD.
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-5105
Mailing Address - Country:US
Mailing Address - Phone:585-368-4050
Mailing Address - Fax:
Practice Address - Street 1:105 CANAL LANDING BLVD.
Practice Address - Street 2:SUITE 1
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-5105
Practice Address - Country:US
Practice Address - Phone:585-368-4050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY090901207R00000X, 207QG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00594312Medicaid
NY00594312Medicaid
NYK71008 / 70008A GRPMedicare PIN
B81161Medicare UPIN