Provider Demographics
NPI:1689635682
Name:REILLY, PHILLIP E (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:E
Last Name:REILLY
Suffix:
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 1:25 HIGHLAND PARK DR
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-8402
Mailing Address - Country:US
Mailing Address - Phone:724-438-3040
Mailing Address - Fax:724-438-3030
Practice Address - Street 1:25 HIGHLAND PARK DR
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-8402
Practice Address - Country:US
Practice Address - Phone:724-438-3040
Practice Address - Fax:724-438-3030
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD009491E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD009491EOtherLICENSE NUMBER
PAD70933Medicare UPIN
PA017598K7PMedicare ID - Type UnspecifiedPROVIDER NUMBER