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General NPI Number Information
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NPI Number | 1497849277
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Entity Type | Individual
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Provider Name | MARY REILLY MD
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Gender | Female
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 09/11/2024
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Provider Practice Location Address
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Address Line | 1505 W OAK ST
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City | ZIONSVILLE
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State | IN
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Zip | 46077-2057
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Country | US
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Telephone | 844-539-8726
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Fax | 844-539-8726
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Provider Business Mailing Address
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Address Line | 1505 W OAK ST STE 130
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City | ZIONSVILLE
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State | IN
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Zip | 46077-2058
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Country | US
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Telephone | 765-571-3094
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Fax | 317-795-1146
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 01049057
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number | 01049057
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 2083B0002X
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Taxonomy Name | Obesity Medicine (Preventive Medicine) Physician
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License Number | IN01049057A
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License Number State | IN
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