Healthcare Provider Details

I. General information

NPI: 1265501647
Provider Name (Legal Business Name): WAYNE C REYNOLDS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 CHILHOWIE ST
CHILHOWIE VA
24319-3461
US

IV. Provider business mailing address

403 CHILHOWIE ST
CHILHOWIE VA
24319-3461
US

V. Phone/Fax

Practice location:
  • Phone: 276-646-3241
  • Fax: 276-646-2592
Mailing address:
  • Phone: 276-646-3241
  • Fax: 276-646-2592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number0101040847
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: