Provider Demographics
NPI:1922083674
Name:REILLY, KIM MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:MARIE
Last Name:REILLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:MARIE
Other - Last Name:SCHLECHTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1011 ROCK QUARRY RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-3825
Mailing Address - Country:US
Mailing Address - Phone:984-464-6749
Mailing Address - Fax:
Practice Address - Street 1:1011 ROCK QUARRY RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-3825
Practice Address - Country:US
Practice Address - Phone:984-464-6749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35078399R208000000X
NC2021-01611208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1204464OtherUHC PIN
OH000000177532OtherUNISON PIN
OH0989499OtherGROUP MEDICAID
RE4028581OtherMEDICARE PTAN
OH000000185154OtherANTHEM PIN
OH311413469053OtherCARESOURCE PIN
OH2189911Medicaid
G71258Medicare UPIN
OH2189911Medicaid
RE4028581Medicare PIN