Provider Demographics
NPI:1932134202
Name:DAHL, REYNOLD J (MD)
Entity type:Individual
Prefix:
First Name:REYNOLD
Middle Name:J
Last Name:DAHL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:9 INDUSTRIAL RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-3588
Mailing Address - Country:US
Mailing Address - Phone:508-473-1480
Mailing Address - Fax:508-473-1210
Practice Address - Street 1:100 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:NORTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01534-1415
Practice Address - Country:US
Practice Address - Phone:508-234-6311
Practice Address - Fax:508-634-4215
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA54988207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ04872OtherBLUE CROSS BLUE SHIELD
MA3001130Medicaid
MAJ04872OtherBLUE CROSS BLUE SHIELD
J04872Medicare ID - Type Unspecified