Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | SC003861 | PA |
Y | 222Z00000X | Podiatrist | SC003861 | PA |
NPI | 1033123526 |
---|---|
Provider Name | Richard L Reilly |
First Address | Blairsville, PA 15717-1370 |
Second Address | Blairsville, PA 15717-1370 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0015223780005 | (05) | PA |
U56362 | (02) | PA |