Provider Demographics
NPI:1124178819
Name:REILLY, ROBERT E (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:REILLY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 LANGHORNE NEWTOWN RD
Mailing Address - Street 2:SUITE 135
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1209
Mailing Address - Country:US
Mailing Address - Phone:215-750-5050
Mailing Address - Fax:215-750-6514
Practice Address - Street 1:1203 LANGHORNE NEWTOWN RD
Practice Address - Street 2:SUITE 135
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1209
Practice Address - Country:US
Practice Address - Phone:215-750-5050
Practice Address - Fax:215-750-6514
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005276L207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA175073JYROtherMEDICARE PTAN
PA175073Medicare ID - Type Unspecified
PA175073JYROtherMEDICARE PTAN
PA175073JYRMedicare PIN