Provider Demographics
NPI:1801814561
Name:O'REILLY, DAVID JOHN (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JOHN
Last Name:O'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 1:100 EAST LIBERTY STREET. SUITE 800
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1434
Mailing Address - Country:US
Mailing Address - Phone:859-986-6675
Mailing Address - Fax:859-276-5939
Practice Address - Street 1:305 ESTILL ST
Practice Address - Street 2:3RD FL
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-1742
Practice Address - Country:US
Practice Address - Phone:859-986-6775
Practice Address - Fax:859-986-6512
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29105207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4000501OtherMEDICARE LAB GROUP
CB5773OtherRR MEDICARE GROUP
060063337OtherRR MEDICARE PIN
KY37903705OtherMEDICAID LAB GROUP
KY64291057Medicaid
KY0624442Medicare ID - Type Unspecified
KY37903705OtherMEDICAID LAB GROUP