Healthcare Provider Details

I. General information

NPI: 1255448395
Provider Name (Legal Business Name): DONALD T REILLY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 12/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 CYPRESS ST
BROOKLINE MA
02445-6776
US

IV. Provider business mailing address

235 CYPRESS ST
BROOKLINE MA
02445-6776
US

V. Phone/Fax

Practice location:
  • Phone: 617-738-8642
  • Fax: 617-738-5045
Mailing address:
  • Phone: 617-738-8642
  • Fax: 617-738-5045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number46658
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: