Provider Demographics
NPI:1962060558
Name:O'REILLY, OLIVIA CLARE (MD)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:CLARE
Last Name:O'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 1:1410 FIRST EDITION DRIVE
Mailing Address - Street 2:UNIT #2910
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703
Mailing Address - Country:US
Mailing Address - Phone:419-346-1521
Mailing Address - Fax:
Practice Address - Street 1:311 TRENT DRIVE SUITE 5270/5282, BOX 104002
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-1009
Practice Address - Country:US
Practice Address - Phone:919-684-0536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-11602207X00000X
NCRTL24-0190207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery