Provider Demographics
NPI:1154317709
Name:REILLY, JOHN J JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:REILLY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550 TERRACE ST
Mailing Address - Street 2:SCAIFE HALL, ROOM 1218
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-2500
Mailing Address - Country:US
Mailing Address - Phone:412-648-9636
Mailing Address - Fax:
Practice Address - Street 1:3550 TERRACE ST
Practice Address - Street 2:SCAIFE HALL, ROOM 1218
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-2500
Practice Address - Country:US
Practice Address - Phone:412-648-9636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA54592207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3018288Medicaid
MAD08889Medicare UPIN
MA3018288Medicaid