Individual
DR. HARRY RICHARD REYNOLDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2345 CHESTERFIELD AVE, SUITE 204, CHARLESTON, WV 25304-1062
(304) 345-3570
(304) 345-3599
Mailing address
2345 CHESTERFIELD AVE, SUITE 204, CHARLESTON, WV 25304-1062
(304) 345-3570
(304) 345-3599
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
WV14661
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0069872000
—
WV
01
—
51D0234293
CLIA
WV
01
—
55-0672861
TAX ID
WV
01
—
WV14661
WV LICENSE
WV
Enumeration date
05/01/2006
Last updated
03/07/2023
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