MEDICARE: DR. HARRY RICHARD REYNOLDS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	WV14661	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51D0234293	OTHER	WV	CLIA
2	55-0672861	OTHER	WV	TAX ID
3	WV14661	OTHER	WV	WV LICENSE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043277270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HARRY RICHARD REYNOLDS M.D.

Provider Business Mailing Address
First Line	:	2345 CHESTERFIELD AVE
Second Line	:	SUITE 204
City	:	CHARLESTON
State	:	WV
Zip	:	25304-1062
Country	:	US
Telephone Number	:	304-345-3570
Fax Number	:	304-345-3599

Provider Business Practice Location Address
First Line	:	2345 CHESTERFIELD AVE
Second Line	:	SUITE 204
City	:	CHARLESTON
State	:	WV
Zip	:	25304-1062
Country	:	US
Telephone Number	:	304-345-3570
Fax Number	:	304-345-3599

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	03/07/2023

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Directions to “ DR. HARRY RICHARD REYNOLDS M.D.” Practice Location

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