Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | C10000828 | DE |
NPI | 1013095314 |
---|---|
Provider Name | Dr. Edward W Mcreynolds |
First Address | Wilmington, DE 19808 |
Second Address | Wilmington, DE 19808 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B66517 | (02) |