Provider Demographics
NPI:1871541219
Name:REYNOLDS, JAMES C (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:C
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3400 CIVIC CENTER BLVD
Mailing Address - Street 2:FL 7
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5163
Mailing Address - Country:US
Mailing Address - Phone:215-255-7822
Mailing Address - Fax:215-255-7825
Practice Address - Street 1:219 N BROAD ST
Practice Address - Street 2:5TH FL
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-1519
Practice Address - Country:US
Practice Address - Phone:215-762-6220
Practice Address - Fax:215-762-5034
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2016-05-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD024261E207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000913358Medicaid
PAB95808Medicare UPIN
PA000913358Medicaid