MEDICARE: DR. MARY ANNE CONKLIN 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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	35.059840	OH
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	4301406532	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194784942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY ANNE CONKLIN REYNOLDS M.D.

Provider Business Mailing Address
First Line	:	3170 W CENTRAL AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43606-2945
Country	:	US
Telephone Number	:	419-534-3500
Fax Number	:	419-534-2608

Provider Business Practice Location Address
First Line	:	3170 W CENTRAL AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43606-2945
Country	:	US
Telephone Number	:	419-534-3500
Fax Number	:	419-534-2608

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

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	01/09/2015

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