Healthcare Provider Details

I. General information

NPI: 1346651692
Provider Name (Legal Business Name): PATRICK DAVID REILLY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7631 CHEVIOT RD
CINCINNATI OH
45247-4012
US

IV. Provider business mailing address

7631 CHEVIOT RD
CINCINNATI OH
45247-4012
US

V. Phone/Fax

Practice location:
  • Phone: 513-923-1886
  • Fax: 513-923-2878
Mailing address:
  • Phone: 513-923-1886
  • Fax: 513-923-2878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35130536
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: