Healthcare Provider Details

I. General information

NPI: 1194525055
Provider Name (Legal Business Name): GARY REYNOLDS MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2025
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST
BOSTON MA
02114-2696
US

IV. Provider business mailing address

32 FRUIT ST
BOSTON MA
02114-2620
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-7938
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number6150188
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: