Provider Demographics
NPI:1013095314
Name:MCREYNOLDS, EDWARD W (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:W
Last Name:MCREYNOLDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5515 KIRKWOOD MILLTOWN PLAZA
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808
Mailing Address - Country:US
Mailing Address - Phone:302-995-7181
Mailing Address - Fax:302-995-7186
Practice Address - Street 1:5515 KIRKWOOD MILLTOWN PLAZA
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808
Practice Address - Country:US
Practice Address - Phone:302-995-7181
Practice Address - Fax:302-995-7186
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10000828208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
B66517Medicare UPIN