Provider Demographics
NPI:1447742325
Name:REILLY, CASEY ANN (PA-C, MMSC)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:ANN
Last Name:REILLY
Suffix:
Gender:F
Credentials:PA-C, MMSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 37174
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3174
Mailing Address - Country:US
Mailing Address - Phone:571-423-5699
Mailing Address - Fax:571-423-5698
Practice Address - Street 1:6354 WALKER LN STE 400
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-3252
Practice Address - Country:US
Practice Address - Phone:571-472-7320
Practice Address - Fax:571-472-7321
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X, 363AS0400X
VA0110008241363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical