Healthcare Provider Details

I. General information

NPI: 1013449867
Provider Name (Legal Business Name): EDWARD J O'REILLY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2017
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CEDAR ST SE STE 306
ALBUQUERQUE NM
87106-4932
US

IV. Provider business mailing address

DERRADDA HOUSE CAVANACAW ROAD
ARMAGH ULSTER
BT602AB
IE

V. Phone/Fax

Practice location:
  • Phone: 505-224-7478
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD2024-1235
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: