Healthcare Provider Details

I. General information

NPI: 1992820740
Provider Name (Legal Business Name): ROBERT WILLIAM REYNOLDS RT(R)(T)
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 UNIVERSITY DR
HERSHEY PA
17033-2360
US

IV. Provider business mailing address

340 CRAIG ST
ERIE PA
16508-2710
US

V. Phone/Fax

Practice location:
  • Phone: 717-531-4889
  • Fax:
Mailing address:
  • Phone: 814-452-4429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471R0002X
TaxonomyRadiation Therapy Radiologic Technologist
License Number207055
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2471R0002X
TaxonomyRadiation Therapy Radiologic Technologist
License NumberT1854925
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2471R0002X
TaxonomyRadiation Therapy Radiologic Technologist
License Number261258
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: