Provider Demographics
NPI:1457473381
Name:DOMOTO-REILLY, KIMIKO (MD)
Entity Type:Individual
Prefix:
First Name:KIMIKO
Middle Name:
Last Name:DOMOTO-REILLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:15 PARKMAN ST
Mailing Address - Street 2:WACC 835
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-3117
Mailing Address - Country:US
Mailing Address - Phone:617-726-1728
Mailing Address - Fax:617-726-4101
Practice Address - Street 1:15 PARKMAN ST
Practice Address - Street 2:WACC 835
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3117
Practice Address - Country:US
Practice Address - Phone:617-726-1728
Practice Address - Fax:617-726-4101
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2011-12-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA2405472084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology