Provider Demographics
NPI:1700900891
Name:REILLY, JOHN ALLEN (MD, MS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALLEN
Last Name:REILLY
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16722 ANNANDALE RD STE D-1
Mailing Address - Street 2:
Mailing Address - City:EMMITSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21727-8908
Mailing Address - Country:US
Mailing Address - Phone:301-662-1512
Mailing Address - Fax:301-662-5589
Practice Address - Street 1:16722 ANNANDALE RD STE D-1
Practice Address - Street 2:
Practice Address - City:EMMITSBURG
Practice Address - State:MD
Practice Address - Zip Code:21727
Practice Address - Country:US
Practice Address - Phone:301-662-1512
Practice Address - Fax:301-662-5589
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD54749207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD444444Medicare ID - Type Unspecified
MDH11020Medicare UPIN