Provider Demographics
NPI:1477655231
Name:REYNOLDS, RADFORD P (MD)
Entity type:Individual
Prefix:
First Name:RADFORD
Middle Name:P
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:200 MILL RD
Mailing Address - Street 2:STE 180
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5252
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:100 ROSEBROOK WAY
Practice Address - Street 2:2ND FL
Practice Address - City:WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02571-2097
Practice Address - Country:US
Practice Address - Phone:508-273-4950
Practice Address - Fax:508-273-4951
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2016-02-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA80184207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110056464AMedicaid
MA110056464AMedicaid
MA467614OtherTUFTS
P00142589OtherRR MEDICARE
MAA22093Medicare ID - Type Unspecified
MAAA27335OtherHPHC
MA4770716OtherCIGNA
F01334Medicare UPIN
MA3145336Medicaid