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Individual

DIEDRE ANN MARIE REYNOLDS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
100 E LEHIGH AVE, PHILADELPHIA, PA 19125-1012
(215) 707-8496
(215) 707-4086
Mailing address
100 E LEHIGH AVE, PHILADELPHIA, PA 19125-1012
(215) 707-8496
(215) 707-4086

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
037092
CT
2084P0800X
Psychiatry Physician
MD438693
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
001370923
CT
Enumeration date
11/10/2005
Last updated
03/30/2010
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