Provider Demographics
NPI:1295720407
Name:REYNOLDS, HAROLD THOMAS (MD)
Entity type:Individual
Prefix:
First Name:HAROLD
Middle Name:THOMAS
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 1:47 BUCKEYE DR
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-7345
Mailing Address - Country:US
Mailing Address - Phone:614-761-7921
Mailing Address - Fax:
Practice Address - Street 1:5975 E BROAD ST
Practice Address - Street 2:STE 302
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1531
Practice Address - Country:US
Practice Address - Phone:614-234-6464
Practice Address - Fax:614-234-6720
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35046224R208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0514036Medicaid
OHRE0531802Medicare PIN
OH0514036Medicaid