Individual
MICHAEL REYNOLDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
930 CHESTNUT RIDGE RD, MORGANTOWN, WV 26505-2807
(304) 598-4214
Mailing address
20 KENWOOD AVENUE, WORCESTER, MA 01605
(508) 304-9188
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
204928
MA
207Q00000X
Family Medicine Physician
31684
WV
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
Primary
31684
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0106071
—
MA
Enumeration date
01/15/2007
Last updated
01/28/2023
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