Healthcare Provider Details

I. General information

NPI: 1053385443
Provider Name (Legal Business Name): DAVID M REILLY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 12/01/2023
Certification Date: 12/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 HOSPITAL WAY SUITE 100
SOMERSET KY
42503-2872
US

IV. Provider business mailing address

3655 KENT DR
NAPLES FL
34112-3753
US

V. Phone/Fax

Practice location:
  • Phone: 606-451-2601
  • Fax: 606-451-2641
Mailing address:
  • Phone: 606-875-1369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number31406
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME134181
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: