MEDICARE: DONALD T 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	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician	46658	MA

General Provider Information

NPI Number	:	1255448395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONALD T REILLY M.D.

Provider Business Mailing Address
First Line	:	235 CYPRESS ST
Second Line	:
City	:	BROOKLINE
State	:	MA
Zip	:	02445-6776
Country	:	US
Telephone Number	:	617-738-8642
Fax Number	:	617-738-5045

Provider Business Practice Location Address
First Line	:	235 CYPRESS ST
Second Line	:
City	:	BROOKLINE
State	:	MA
Zip	:	02445-6776
Country	:	US
Telephone Number	:	617-738-8642
Fax Number	:	617-738-5045

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

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	12/03/2010

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