MEDICARE: DR. JOHN RICHARD REILLY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	MD16171	DC

General Provider Information

NPI Number	:	1124061510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN RICHARD REILLY M.D.

Provider Business Mailing Address
First Line	:	4200 WISCONSIN AVE NW
Second Line	:	#223
City	:	WASHINGTON
State	:	DC
Zip	:	20016-2143
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4200 WISCONSIN AVE NW
Second Line	:	#223
City	:	WASHINGTON
State	:	DC
Zip	:	20016-2143
Country	:	US
Telephone Number	:	202-466-1800
Fax Number	:	202-452-1542

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	01/10/2013

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