Provider Demographics
NPI:1043202534
Name:REYNOLDS, MARCI ANN (MD)
Entity type:Individual
Prefix:DR
First Name:MARCI
Middle Name:ANN
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 HOOSICK ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-2427
Mailing Address - Country:US
Mailing Address - Phone:518-271-1331
Mailing Address - Fax:518-271-8712
Practice Address - Street 1:258 HOOSICK ST
Practice Address - Street 2:SUITE 106
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-2427
Practice Address - Country:US
Practice Address - Phone:518-271-1331
Practice Address - Fax:518-271-8712
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214858208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01975497Medicaid