Healthcare Provider Details

I. General information

NPI: 1326099094
Provider Name (Legal Business Name): GEORGE E REYNOLDS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 05/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 SPRINGFIELD RD SUITE 1
WESTFIELD MA
01085-1832
US

IV. Provider business mailing address

75 SPRINGFIELD RD SUITE 1
WESTFIELD MA
01085-1832
US

V. Phone/Fax

Practice location:
  • Phone: 413-562-5173
  • Fax: 413-562-1716
Mailing address:
  • Phone: 413-562-5173
  • Fax: 413-562-1716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number33284
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: