Provider Demographics
NPI:1215989876
Name:REYNOLDS, LANCE DAVID (MD)
Entity type:Individual
Prefix:
First Name:LANCE
Middle Name:DAVID
Last Name:REYNOLDS
Suffix:
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 1:75 SPRINGFIELD RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-1832
Mailing Address - Country:US
Mailing Address - Phone:413-562-5173
Mailing Address - Fax:413-562-1716
Practice Address - Street 1:75 SPRINGFIELD RD
Practice Address - Street 2:SUITE 1
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-1832
Practice Address - Country:US
Practice Address - Phone:413-562-5173
Practice Address - Fax:413-562-1716
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA210369207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0175391Medicaid
MA0175391Medicaid
A34435Medicare ID - Type Unspecified