Provider Demographics
NPI:1922395714
Name:REILLY, MICHAEL J (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:REILLY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1235 OLD YORK ROAD
Mailing Address - Street 2:SUITE 121
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001
Mailing Address - Country:US
Mailing Address - Phone:215-517-1200
Mailing Address - Fax:215-517-1219
Practice Address - Street 1:1235 OLD YORK RD STE 121
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-3840
Practice Address - Country:US
Practice Address - Phone:215-517-1200
Practice Address - Fax:215-517-1219
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS017103207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103065020Medicaid