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General NPI Number Information
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NPI Number | 1245568963
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Entity Type | Organization
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Legal Business Name | MARL E REYNOLDS MD INC
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Dates
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Enumeration Date | 11/19/2009
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Last Update Date | 08/11/2011
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Provider Practice Location Address
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Address Line | 4301 STATE ROUTE 725 STE B
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City | BELLBROOK
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State | OH
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Zip | 45305-1552
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Country | US
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Telephone | 937-848-9858
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Fax | 937-848-2080
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Provider Business Mailing Address
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Address Line | 4301 STATE ROUTE 725 STE B
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City | BELLBROOK
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State | OH
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Zip | 45305-1552
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Country | US
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Telephone | 937-848-9858
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Fax | 937-848-2080
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Authorized Official
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Title or Position | OWNER
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Name | MARK E REYNOLDS
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Credential | M.D.
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Telephone | 937-848-9858
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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