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General NPI Number Information
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NPI Number | 1457333866
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Entity Type | Individual
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Provider Name | MARCELLE JENNIFER REILLY D.O.
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Gender | Female
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Dates
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Enumeration Date | 11/19/2005
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Last Update Date | 06/04/2021
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Provider Practice Location Address
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Address Line | 16290 E QUINCY AVE
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City | AURORA
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State | CO
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Zip | 80015-1594
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Country | US
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Telephone | 303-338-4545
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Fax |
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Provider Business Mailing Address
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Address Line | 10350 E DAKOTA AVE
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City | DENVER
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State | CO
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Zip | 80247-1314
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 227525
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DR.0059961
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License Number State | CO
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