Provider Demographics
NPI:1790892099
Name:REYNOLDS, RACHEL VICTORIA (MD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:VICTORIA
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:RACHEL
Other - Middle Name:VICTORIA
Other - Last Name:SABBAG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:330 BROOKLINE AVE
Mailing Address - Street 2:SHAPIRO BLDG 2ND FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5400
Mailing Address - Country:US
Mailing Address - Phone:617-667-3753
Mailing Address - Fax:617-975-5033
Practice Address - Street 1:330 BROOKLINE AVE
Practice Address - Street 2:SHAPIRO BLDG. 2ND FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5400
Practice Address - Country:US
Practice Address - Phone:617-667-3753
Practice Address - Fax:617-975-5033
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA203757207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0100111Medicaid
MAH17242Medicare UPIN
A31143Medicare ID - Type Unspecified