Provider Demographics
NPI:1902887342
Name:REILLY, JOSEPH MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MICHAEL
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 1:1733 HOWELL RD
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-6638
Mailing Address - Country:US
Mailing Address - Phone:301-797-2525
Mailing Address - Fax:301-797-5519
Practice Address - Street 1:1733 HOWELL RD
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-6638
Practice Address - Country:US
Practice Address - Phone:301-797-2525
Practice Address - Fax:301-797-5519
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0029302207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1140724OtherUNITED HEALTHCARE
MD1314019001OtherCIGNA
WV3004298000Medicaid
MD35053808OtherBC/BS
PA540587OtherBC/BS
MD464351800Medicaid
145744300OtherUS DEPT OF LABOR
DCB3890007OtherBC/BS
MD1140724OtherUNITED HEALTHCARE
MD060069264Medicare ID - Type UnspecifiedRAILROAD MEDICARE
PA540587OtherBC/BS