Provider Demographics
NPI:1811962319
Name:REILLY, PAUL A (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:A
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 1:315 7TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW KENSINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15068-6529
Mailing Address - Country:US
Mailing Address - Phone:724-337-6232
Mailing Address - Fax:724-337-6721
Practice Address - Street 1:315 7TH ST
Practice Address - Street 2:
Practice Address - City:NEW KENSINGTON
Practice Address - State:PA
Practice Address - Zip Code:15068-6529
Practice Address - Country:US
Practice Address - Phone:724-337-6232
Practice Address - Fax:724-337-6721
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030294E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001190044Medicaid
PAP00356664Medicare PIN
PA421462Medicare PIN
PAE52635Medicare UPIN