Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 0101253876 | VA |
NPI | 1003130675 |
---|---|
Provider Name | Dr. Austin Windsor Reynolds |
First Address | Alexandria, VA 22307-1901 |
Second Address | Alexandria, VA 22306-3209 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2010 |
Last Update Date | 01/09/2015 |