Individual
DR. DERMOT M. REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5301 W GENESEE ST, CAMILLUS, NY 13031-2260
(607) 798-5971
(315) 833-9998
Mailing address
5301 W GENESEE ST, CAMILLUS, NY 13031-2260
(607) 798-5971
(315) 833-9998
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
250206-01
NY
207X00000X
Orthopaedic Surgery Physician
MD422314
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02521846
—
NY
05
—
1008319990001
—
PA
05
—
1487627139
—
NY
01
—
CC9269
RR MEDICARE GROUP
PA
01
—
GU039978
PA MEDICARE GROUP
PA
01
—
P00120718
RR MEDICARE PIN
PA
01
—
PA MEDICARE GROUP
GU039809
PA
Enumeration date
02/10/2006
Last updated
12/02/2020
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