Provider Demographics
NPI:1053392100
Name:REILLY, JOSEPH GARRETT (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:GARRETT
Last Name:REILLY
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3418 OLANDWOOD CT
Mailing Address - Street 2:SUITE 111
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1375
Mailing Address - Country:US
Mailing Address - Phone:301-774-8198
Mailing Address - Fax:301-774-8199
Practice Address - Street 1:3418 OLANDWOOD CT
Practice Address - Street 2:SUITE 111
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1375
Practice Address - Country:US
Practice Address - Phone:301-774-8198
Practice Address - Fax:301-774-8199
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD-39190207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD07701Medicaid
MDE-13402Medicare UPIN
RE-123640Medicare ID - Type Unspecified