Healthcare Provider Details

I. General information

NPI: 1154317709
Provider Name (Legal Business Name): JOHN J. REILLY JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 08/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 TERRACE ST SCAIFE HALL, ROOM 1218
PITTSBURGH PA
15213-2500
US

IV. Provider business mailing address

3550 TERRACE ST SCAIFE HALL, ROOM 1218
PITTSBURGH PA
15213-2500
US

V. Phone/Fax

Practice location:
  • Phone: 412-648-9636
  • Fax:
Mailing address:
  • Phone: 412-648-9636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number54592
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number54592
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: