Healthcare Provider Details

I. General information

NPI: 1760168892
Provider Name (Legal Business Name): DAVID REYNOSO CORTEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DAVID REYNOSO MD

II. Dates (important events)

Enumeration Date: 06/23/2023
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 ANNAPOLIS RD
ODENTON MD
21113-1637
US

IV. Provider business mailing address

1106 ANNAPOLIS RD
ODENTON MD
21113-1637
US

V. Phone/Fax

Practice location:
  • Phone: 410-874-1400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0106993
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT-227777
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: