Provider Demographics
NPI:1427055060
Name:REILLY, SHARON A (MD)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:A
Last Name:REILLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 VAUGHN RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27217-2863
Mailing Address - Country:US
Mailing Address - Phone:336-352-0000
Mailing Address - Fax:336-352-0001
Practice Address - Street 1:1214 VAUGHN RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-2863
Practice Address - Country:US
Practice Address - Phone:336-352-0000
Practice Address - Fax:336-352-0001
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058057207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
186394OtherANTHEM PROVIDER NUMBER
203639329OtherUNITED HEALTHCARE PROVIDE
203639329014OtherTRICARE PROVIDER NUMBER
700011400OtherCIGNA PROVIDER NUMBER
329085OtherSOUTHERN HEALTH PROVIDER
56162 (A0643)OtherMEDCOST PROVIDER NUMBER
010214980OtherVA PREMIER PROVIDER NUMBE
20-3639329OtherPCHP PROVIDER NUMBER
VA010214980Medicaid
28180OtherSENTARA/OPTIMA PROVIDER N
203639329014OtherTRICARE PROVIDER NUMBER
VAH22239Medicare UPIN
VA010214980Medicaid
014910C39Medicare PIN