Provider Demographics
NPI:1285602086
Name:REILLY, ERIN P (MD)
Entity type:Individual
Prefix:DR
First Name:ERIN
Middle Name:P
Last Name:REILLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ERIN
Other - Middle Name:P
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1520 KNOX AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-4010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:860 BELTLINE RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-1091
Practice Address - Country:US
Practice Address - Phone:541-222-6005
Practice Address - Fax:541-222-6029
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD18391207PE0004X, 207Q00000X
SC31525207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR056833Medicaid
ORR103758Medicare PIN
OR056833Medicaid