NPIMap

Individual provider Active NPI

Harry Richard Reynolds, M.D.

  • Dermatology Physician
  • Charleston, WV
National Provider Identifier
1043277270
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
WV14661 Issued in WV
Practice address
2345 Chesterfield Ave
Suite 204
Charleston, WV 25304-1062
Phone
(304) 345-3570
Fax
(304) 345-3599
NPI assigned
May 1, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X WV14661 WV Primary

Addresses

Primary practice location

2345 Chesterfield Ave
Suite 204
Charleston, WV 25304-1062

Mailing address

2345 Chesterfield Ave
Suite 204
Charleston, WV 25304-1062
Phone (304) 345-3570

Other identifiers 4

IdentifierTypeStateIssuer
51D0234293OtherWVCLIA
55-0672861OtherWVTAX ID
WV14661OtherWVWV LICENSE
0069872000MedicaidWV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120604000374 WV Practitioner - Dermatology 8921262973 Practice locations: Charleston, WV

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
West Virginia University School of Medicine, 1982
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

2345 Chesterfield Ave
Suite 204
Charleston, WV 25304-1063
Phone (304) 345-3570

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
0 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
0

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision47
Removal of skin lesions761
Removal or shaving of skin growth1-10
Skin biopsy290

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1043277270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2345 CHESTERFIELD AVE",
            "address_2": "SUITE 204",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253041062",
            "telephone_number": "304-345-3570",
            "fax_number": "304-345-3599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2345 CHESTERFIELD AVE",
            "address_2": "SUITE 204",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253041062",
            "telephone_number": "304-345-3570",
            "fax_number": "304-345-3599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "HARRY",
        "middle_name": "RICHARD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-01",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "WV",
            "license": "WV14661",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "51D0234293",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "55-0672861",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WV LICENSE",
            "identifier": "WV14661",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0069872000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, WV

Sources for this page

Verify at the official NPI Registry.