Provider Demographics
NPI:1881655504
Name:REYNOLDS, JAMES MILTON (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MILTON
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:PO BOX 910
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25712-0910
Mailing Address - Country:US
Mailing Address - Phone:304-522-1550
Mailing Address - Fax:304-522-0704
Practice Address - Street 1:5221 US ROUTE 60 E
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-2022
Practice Address - Country:US
Practice Address - Phone:304-522-1550
Practice Address - Fax:304-522-0704
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2020-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY413312085R0204X, 2085R0202X
WV227472085R0204X, 2085R0202X
OH35.0899682085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001968335OtherMTN ST BC/BS
KY7100026730Medicaid
WVP00413753OtherRR MEDICARE
WV3810008991Medicaid
7436821OtherAETNA
OH000000221845OtherUNISON
OH2747273Medicaid
OH000000221845OtherUNISON
KY7100026730Medicaid
I50606Medicare UPIN
OH2747273Medicaid