Provider Demographics
NPI:1861465635
Name:RAYNOR, REGINALD WINFIELD III (MD)
Entity type:Individual
Prefix:
First Name:REGINALD
Middle Name:WINFIELD
Last Name:RAYNOR
Suffix:III
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 1:29 HAYNES ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-4139
Mailing Address - Country:US
Mailing Address - Phone:860-646-8888
Mailing Address - Fax:860-646-8885
Practice Address - Street 1:29 HAYNES ST
Practice Address - Street 2:SUITE B
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-4139
Practice Address - Country:US
Practice Address - Phone:860-646-8888
Practice Address - Fax:860-646-8885
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT26317208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001263177Medicaid
CT020001634Medicare PIN
CTB39704Medicare UPIN