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NPI Code Detail

MEDICARE: DR. BRADLEY S REYNOLDS

MEDICARE: DR. BRADLEY S REYNOLDS
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
1103TC0700XClinical Psychologist6293MA

General Provider Information

NPI Number : 1972565729
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRADLEY S REYNOLDS
Provider Business Mailing Address
First Line : 38 WACHUSETT DRIVE
Second Line :
City : LEXINGTON
State : MA
Zip : 02421-6913
Country : US
Telephone Number : 781-367-7903
Fax Number :
Provider Business Practice Location Address
First Line : 218 EAST RD
Second Line : HAMPSTEAD HOSPITAL
City : HAMPSTEAD
State : NH
Zip : 03841-2305
Country : US
Telephone Number : 603-329-5311
Fax Number : 603-329-9374
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2006
Last Update Date : 06/13/2008

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