Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | A102718 | CA |
NPI | 1104095827 |
---|---|
Provider Name | Michael Joseph Reilly |
First Address | Boston, MA 02241-8498 |
Second Address | Washington, DC 20007-2113 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2008 |
Last Update Date | 14/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0A1027180 | (05) | CA |
P00894821 | RAILROAD MEDICARE (01) | DC |