Healthcare Provider Details

I. General information

NPI: 1023052503
Provider Name (Legal Business Name): MARK STEVEN REYNOLDS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

923 BROAD ST
DURHAM NC
27705-4141
US

IV. Provider business mailing address

6 GATLIN CT
DURHAM NC
27707-5395
US

V. Phone/Fax

Practice location:
  • Phone: 919-220-4224
  • Fax: 919-220-7309
Mailing address:
  • Phone: 919-475-7043
  • Fax: 919-220-7309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number32957
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: