Healthcare Provider Details

I. General information

NPI: 1912334392
Provider Name (Legal Business Name): JAMES CARTER REYNOLDS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2013
Last Update Date: 10/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NATIONAL INSTITUTES OF HEALTH 10 CENTER DRIVE; BLDG 10; ROOM 1C-461
BETHESDA MD
20892-0001
US

IV. Provider business mailing address

NATIONAL INSTITUTES OF HEALTH 10 CENTER DRIVE; BLDG 10; ROOM 1C-461
BETHESDA MD
20892-0001
US

V. Phone/Fax

Practice location:
  • Phone: 301-496-5675
  • Fax:
Mailing address:
  • Phone: 301-496-5675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License Number16173-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: