Provider Demographics
NPI:1124095427
Name:REILLY, MEGAN M (MD)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:M
Last Name:REILLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MEGAN
Other - Middle Name:R
Other - Last Name:JENNINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2855 CAMPUS DR
Mailing Address - Street 2:#350
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-2649
Mailing Address - Country:US
Mailing Address - Phone:763-520-1200
Mailing Address - Fax:763-520-1201
Practice Address - Street 1:2855 CAMPUS DR
Practice Address - Street 2:#350
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-2649
Practice Address - Country:US
Practice Address - Phone:763-520-1200
Practice Address - Fax:763-520-1201
Is Sole Proprietor?:No
Enumeration Date:2006-03-06
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN44068208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH60462Medicare UPIN