Individual
MARK STEPHEN REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
14215 BALLANTYNE CORPORATE PARK, SUITE 130, CHARLOTTE, NC 28277
(704) 384-1950
(704) 384-1955
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-7840
(704) 384-7830
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
200300689
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89134U9
—
NC
05
—
N0068G
—
SC
Enumeration date
08/18/2005
Last updated
03/07/2023
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