Provider Demographics
NPI:1023052503
Name:REYNOLDS, MARK STEVEN (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEVEN
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6 GATLIN CT
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-5395
Mailing Address - Country:US
Mailing Address - Phone:919-475-7043
Mailing Address - Fax:919-220-7309
Practice Address - Street 1:923 BROAD ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-4141
Practice Address - Country:US
Practice Address - Phone:919-220-4224
Practice Address - Fax:919-220-7309
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC329572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2342249OtherGROUP MEDICARE