Provider Demographics
NPI:1942293360
Name:REYNOLDS, AMY M (DO)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1086 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-4305
Mailing Address - Country:US
Mailing Address - Phone:814-410-8300
Mailing Address - Fax:814-410-8331
Practice Address - Street 1:207 WOODSTOWN HWY
Practice Address - Street 2:
Practice Address - City:HOLLSOPPLE
Practice Address - State:PA
Practice Address - Zip Code:15935-7119
Practice Address - Country:US
Practice Address - Phone:814-479-4034
Practice Address - Fax:814-479-7166
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2011-05-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS010616L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I34084Medicare UPIN
PA092372Medicare PIN