Provider Demographics
NPI:1972583946
Name:REILLY, ANDREA JEANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:JEANNE
Last Name:REILLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-267-7171
Mailing Address - Fax:617-262-2608
Practice Address - Street 1:388 COMMONWEALTH AVE MBB
Practice Address - Street 2:MGH BACK BAY
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-2800
Practice Address - Country:US
Practice Address - Phone:617-267-7171
Practice Address - Fax:617-262-2608
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA156935207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0107981Medicaid
MA156935OtherTUFTS HEALTH PLAN
MAJ22565OtherBCBS MA
MAA31477Medicare ID - Type Unspecified
MA0107981Medicaid