Healthcare Provider Details

I. General information

NPI: 1487095683
Provider Name (Legal Business Name): ALEXANDRIA A REILLY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2013
Last Update Date: 06/26/2021
Certification Date: 06/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12201 PLUM ORCHARD DR
SILVER SPRING MD
20904-7803
US

IV. Provider business mailing address

2101 E JEFFERSON ST SUITE 6W PPQA
ROCKVILLE MD
20852-4908
US

V. Phone/Fax

Practice location:
  • Phone: 301-572-1000
  • Fax:
Mailing address:
  • Phone: 301-816-5853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD82119
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: