Provider Demographics
NPI:1962841890
Name:REYNOLDS, DANIELLE LASHAWNE (MD)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:LASHAWNE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1161 OMEGA DR
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5574
Mailing Address - Country:US
Mailing Address - Phone:301-393-2600
Mailing Address - Fax:
Practice Address - Street 1:1161 OMEGA DR
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5574
Practice Address - Country:US
Practice Address - Phone:301-393-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD81437208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics