Provider Demographics
NPI:1548280241
Name:REYNOLDS, HARRY L JR (MD)
Entity type:Individual
Prefix:
First Name:HARRY
Middle Name:L
Last Name:REYNOLDS
Suffix:JR
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 1:24701 EUCLID AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-7874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-054245208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2042177Medicaid
OH363949OtherWELLCARE
OH000000221055OtherUNISON
000000503702OtherANTHEM
5788605OtherAETNA
OH746002OtherBUCKEYE
OHP00113985OtherRAILROAD MEDICARE
OHP00113985OtherRAILROAD MEDICARE
RE0840573Medicare PIN
OHP00823788Medicare PIN
OH363949OtherWELLCARE