Provider Demographics
NPI:1174954929
Name:REYNOLDS, EDWARD (MBA)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 WESTWIND DR
Mailing Address - Street 2:
Mailing Address - City:CORAOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15108-3866
Mailing Address - Country:US
Mailing Address - Phone:724-457-2329
Mailing Address - Fax:
Practice Address - Street 1:105 WESTWIND DR
Practice Address - Street 2:
Practice Address - City:CORAOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15108-3866
Practice Address - Country:US
Practice Address - Phone:724-457-2329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-04
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
No146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate