Basic Information
Provider Information
NPI: 1548348485
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: O'REILLY
FirstName: GERALYN
MiddleName: C
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: CAMACHO
OtherFirstName: GERALYN
OtherMiddleName: A.
OtherNamePrefix: DR.
OtherNameSuffix:  
OtherCredential: M.D.
OtherLastNameType: 5
Mailing Information
Address1: 2401 W BELVEDERE AVE
Address2: ATTN: CREDENTIALING
City: BALTIMORE
State: MD
PostalCode: 212155216
CountryCode: US
TelephoneNumber: 4106015524
FaxNumber: 4106018946
Practice Location
Address1: 2401 W BELVEDERE AVE
Address2: BLAUSE
City: BALTIMORE
State: MD
PostalCode: 212155216
CountryCode: US
TelephoneNumber: 4106016370
FaxNumber: 4106019444
Other Information
ProviderEnumerationDate: 11/01/2006
LastUpdateDate: 10/18/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000XD0065235MDN Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 
207VM0101XD0065235MDY Allopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine

No ID Information.


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