Provider Demographics
NPI:1558365916
Name:REILLEY, ANN FORD (MD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:FORD
Last Name:REILLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8425 CUMBERLAND PL
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-6544
Mailing Address - Country:US
Mailing Address - Phone:225-924-7514
Mailing Address - Fax:225-930-0987
Practice Address - Street 1:8425 CUMBERLAND PL
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-6544
Practice Address - Country:US
Practice Address - Phone:225-924-7514
Practice Address - Fax:225-930-0987
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA015200208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1360945Medicaid
LA13-00045OtherUNITED
LA690254OtherAETNA
LAB62312Medicare UPIN
LA1360945Medicaid