Provider Demographics
NPI:1457333866
Name:REILLY, MARCELLE JENNIFER (DO)
Entity Type:Individual
Prefix:DR
First Name:MARCELLE
Middle Name:JENNIFER
Last Name:REILLY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10350 E DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-1314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16290 E QUINCY AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-1594
Practice Address - Country:US
Practice Address - Phone:303-338-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-19
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227525207Q00000X
CODR.0059961207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7157690OtherAETNA
NY131794OtherGHI-HMO
NY10075805OtherCDPHP
NY3004538OtherMVP HEALTHCARE
NY080820000089OtherFIDELIS
CO028867OtherKAISER COMMERCIAL NUMBER
NY300931OtherSENIOR WHOLE HEALTH
NY02503340Medicaid
NY6016D1OtherEMPIRE BC
NY000404619006OtherBSNENY
CO9000164249Medicaid