Healthcare Provider Details

I. General information

NPI: 1316555295
Provider Name (Legal Business Name): CHRISTIAN SCOTT O'REILLY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2020
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date: 06/03/2022
Reactivation Date: 07/19/2022

III. Provider practice location address

1 PINCKNEY BLVD
BEAUFORT SC
29902-6122
US

IV. Provider business mailing address

1 PINCKNEY BLVD
BEAUFORT SC
29902-6122
US

V. Phone/Fax

Practice location:
  • Phone: 843-228-7424
  • Fax:
Mailing address:
  • Phone: 843-228-7424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number0102208100
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: