Provider Demographics
NPI:1902811730
Name:AGARD, REYNOLD S (MD)
Entity Type:Individual
Prefix:
First Name:REYNOLD
Middle Name:S
Last Name:AGARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 E MAIN ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-7128
Mailing Address - Country:US
Mailing Address - Phone:302-366-0550
Mailing Address - Fax:302-366-8905
Practice Address - Street 1:314 E MAIN ST
Practice Address - Street 2:SUITE 103
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-7128
Practice Address - Country:US
Practice Address - Phone:302-366-0550
Practice Address - Fax:302-366-8905
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAC10005529207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000972911Medicaid
DEH00339Medicare UPIN
DEO13140P86Medicare PIN