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General NPI Number Information
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NPI Number | 1487627139
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Entity Type | Individual
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Provider Name | DERMOT M. REYNOLDS M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/10/2006
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Last Update Date | 12/02/2020
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Provider Practice Location Address
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Address Line | 5301 W GENESEE ST
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City | CAMILLUS
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State | NY
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Zip | 13031-2260
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Country | US
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Telephone | 607-798-5971
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Fax | 315-833-9998
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Provider Business Mailing Address
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Address Line | 5301 W GENESEE ST
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City | CAMILLUS
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State | NY
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Zip | 13031-2260
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Country | US
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Telephone | 607-798-5971
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Fax | 315-833-9998
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | MD422314
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 250206-01
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License Number State | NY
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