MEDICARE: DR. DAVID DEWITT REYNOLDS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	MD043252L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110163810	OTHER	PA	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	RE725073	OTHER	PA	BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	2400390	OTHER	PA	GHI
5	9036990	OTHER	PA	PHCS
6	0562453000	OTHER	PA	AMERIHEALTH
7	804628	OTHER	PA	FIRST PRIORITY

General Provider Information

NPI Number	:	1003829474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID DEWITT REYNOLDS M.D.

Provider Business Mailing Address
First Line	:	1860 FAIR AVE.
Second Line	:	SUITE A
City	:	HONESDALE
State	:	PA
Zip	:	18431-1032
Country	:	US
Telephone Number	:	570-253-3391
Fax Number	:	570-253-1811

Provider Business Practice Location Address
First Line	:	1860 FAIR AVE.
Second Line	:	SUITE A
City	:	HONESDALE
State	:	PA
Zip	:	18431-1032
Country	:	US
Telephone Number	:	570-253-3391
Fax Number	:	570-253-1811

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	02/20/2013

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Directions to “ DR. DAVID DEWITT REYNOLDS M.D.” Practice Location

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