Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 592 | NC |
N | 222Z00000X | Podiatrist | 592 | NC |
Y | 213ES0103X | Foot & Ankle Surgery | 592 | NC |
N | 213ES0103X | Foot & Ankle Surgery | BL8403747-WR1120 | IL |
NPI | 1043581812 |
---|---|
Provider Name | Dr. Cullan Robert Reilly |
First Address | Charlotte, NC 28260-2362 |
Second Address | Salisbury, NC 28144-6253 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2012 |
Last Update Date | 25/10/2020 |