Sean Reynolds, MB BCH BAO

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

LP03737 Issued in RI

Practice address

1701 Divisadero St
San Francisco, CA 94115

Phone

(415) 353-7880

NPI assigned

Jul 1, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The Children'S Mercy Hospital

  • Children's Hospital
  • Overland Park, KS
  • NPI 1154400232
  NPD (past)

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

{
    "created_epoch": "1341100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561334400000",
    "number": "1295099570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 DIVISADERO ST",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941153011",
            "telephone_number": "415-353-7880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 DIVISADERO ST",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "94115",
            "telephone_number": "415-353-7880"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "593 Eddy St",
            "address_2": "APC 1018 Department of Dermatology",
            "address_purpose": "LOCATION",
            "city": "Providence",
            "state": "RI",
            "postal_code": "029034923",
            "country_code": "US",
            "telephone_number": "617-750-1633",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "SEAN",
        "name_prefix": "Dr.",
        "credential": "MB BCH BAO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-07-01",
        "last_updated": "2019-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MA",
            "license": "264533",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "RI",
            "license": "LP03737",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anthony Reynolds, SUDRCII 23014
• Hailey Elizabeth Reynolds, CRNA
• Lindsay Anne Reynolds
• Patcharin J. Reynolds
• Peter Barrett Reynolds
• Sean Reynolds, MSW
• Stephanie Reynolds
• Stephen Reynolds, M.D.
• Sue Ann Ann Reynolds
• Teri Reynolds, MD

• Dermatology Physician in San Francisco, CA
• Providers in San Francisco, CA by specialty
• Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.