Healthcare Provider Details

I. General information

NPI: 1487661336
Provider Name (Legal Business Name): MARGARET A REYNOLDS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 HARVARD ST SE
MINNEAPOLIS MN
55455-0363
US

IV. Provider business mailing address

420 DELAWARE ST SE
MINNEAPOLIS MN
55455-0302
US

V. Phone/Fax

Practice location:
  • Phone: 612-273-3000
  • Fax:
Mailing address:
  • Phone: 612-273-6700
  • Fax: 612-276-8459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number37567
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number37567
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: