Provider Demographics
NPI:1902196090
Name:REYNOLDS, ADAM SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:SCOTT
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 1:15 PARKMAN ST.
Mailing Address - Street 2:WANG 340
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114
Mailing Address - Country:US
Mailing Address - Phone:617-726-8810
Mailing Address - Fax:617-726-3441
Practice Address - Street 1:15 PARKMAN ST.
Practice Address - Street 2:WANG 340
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-726-8810
Practice Address - Fax:617-726-3441
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ525062084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ167135Medicaid