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General NPI Number Information
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NPI Number | 1336571843
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Entity Type | Individual
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Provider Name | CARRIE M REYNOLDS M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/07/2013
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Last Update Date | 02/06/2026
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Provider Practice Location Address
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Address Line | 50 MAUDE ST
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City | PROVIDENCE
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State | RI
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Zip | 02908-4325
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Country | US
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Telephone | 212-734-6621
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Fax |
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Provider Business Mailing Address
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Address Line | 5 SCENIC VIEW DR
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City | WATERFORD
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State | CT
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Zip | 06385-1138
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 60596
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 1115648-63538
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License Number State | NY
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