Provider Demographics
NPI:1821014275
Name:REYNOLDS, JAY M (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:M
Last Name:REYNOLDS
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 1:23 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:FORT FAIRFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04742-1021
Mailing Address - Country:US
Mailing Address - Phone:207-768-4753
Mailing Address - Fax:207-768-4748
Practice Address - Street 1:23 HIGH ST
Practice Address - Street 2:
Practice Address - City:FORT FAIRFIELD
Practice Address - State:ME
Practice Address - Zip Code:04742-1021
Practice Address - Country:US
Practice Address - Phone:207-768-4753
Practice Address - Fax:207-768-4748
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME013765207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEAS OF 5/1/98OtherHEALTHNET
ME260600099Medicaid
ME3320494OtherAETNA HMO
MEAS OF 7/1/05OtherBENEFIT SERVICES
ME5385624OtherAETNA NON HMO
MEM93691OtherCIGNA
MEME0366OtherHARVARD PILGRIM
ME046597OtherANTHEM
ME002824OtherMARTINS POINT
ME138128908OtherUNITED HEALTHCARE
ME3320494OtherAETNA HMO
MEMM5591Medicare PIN