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NPI Code Detail

MEDICARE: REYNOLD J DAHL M.D.

MEDICARE: REYNOLD J DAHL 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
1207Q00000XFamily Medicine Physician54988MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1J04872OTHERMABLUE CROSS BLUE SHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1932134202
Entity Type Code : Individual
Provider Name (Legal Business Name) : REYNOLD J DAHL M.D.
Provider Business Mailing Address
First Line : 9 INDUSTRIAL RD
Second Line : SUITE 5
City : MILFORD
State : MA
Zip : 01757-3588
Country : US
Telephone Number : 508-473-1480
Fax Number : 508-473-1210
Provider Business Practice Location Address
First Line : 100 COMMERCE DR
Second Line :
City : NORTHBRIDGE
State : MA
Zip : 01534-1415
Country : US
Telephone Number : 508-234-6311
Fax Number : 508-634-4215
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2006
Last Update Date : 12/12/2014

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