Provider Demographics
NPI:1841468741
Name:REYNOLDS, DIANNE LOUISE (MD)
Entity type:Individual
Prefix:DR
First Name:DIANNE
Middle Name:LOUISE
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 1:5335 WISCONSIN AVE NW
Mailing Address - Street 2:SUITE 440
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-2030
Mailing Address - Country:US
Mailing Address - Phone:202-274-1814
Mailing Address - Fax:
Practice Address - Street 1:5335 WISCONSIN AVE NW
Practice Address - Street 2:SUITE 440
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-2030
Practice Address - Country:US
Practice Address - Phone:202-274-1814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD 318022084P0804X, 2084P0800X
VA01012627712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry