Healthcare Provider Details

I. General information

NPI: 1013095314
Provider Name (Legal Business Name): EDWARD W MCREYNOLDS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5515 KIRKWOOD MILLTOWN PLAZA
WILMINGTON DE
19808
US

IV. Provider business mailing address

5515 KIRKWOOD MILLTOWN PLAZA
WILMINGTON DE
19808
US

V. Phone/Fax

Practice location:
  • Phone: 302-995-7181
  • Fax: 302-995-7186
Mailing address:
  • Phone: 302-995-7181
  • Fax: 302-995-7186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC10000828
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: