Healthcare Provider Details

I. General information

NPI: 1043277270
Provider Name (Legal Business Name): HARRY RICHARD REYNOLDS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 CHESTERFIELD AVE SUITE 204
CHARLESTON WV
25304-1062
US

IV. Provider business mailing address

2345 CHESTERFIELD AVE SUITE 204
CHARLESTON WV
25304-1062
US

V. Phone/Fax

Practice location:
  • Phone: 304-345-3570
  • Fax: 304-345-3599
Mailing address:
  • Phone: 304-345-3570
  • Fax: 304-345-3599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberWV14661
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: