Provider Demographics
NPI:1447293147
Name:REYNOLDS, THOMAS LEHMAN (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:LEHMAN
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4368 DRESSLER RD NW STE 103
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2776
Mailing Address - Country:US
Mailing Address - Phone:330-433-1300
Mailing Address - Fax:330-494-0828
Practice Address - Street 1:4368 DRESSLER RD. NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718
Practice Address - Country:US
Practice Address - Phone:330-433-1300
Practice Address - Fax:330-494-0828
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0849982084P0804X
MTMED-PHYS-COM-LIC-1302084P0800X
WI102320-8752084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100294888Medicaid
OH2519957Medicaid
OH35-084998OtherSTATE LICENSE