Basic Information
| Provider Information | |||||||||
| NPI: | 1669433785 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REILLY | ||||||||
| FirstName: | W | ||||||||
| MiddleName: | TERENCE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 406 DELAWARE AVE | ||||||||
| Address2: | |||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180151469 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108662600 | ||||||||
| FaxNumber: | 6108617640 | ||||||||
| Practice Location | |||||||||
| Address1: | 406 DELAWARE AVE | ||||||||
| Address2: | |||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180151469 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108662600 | ||||||||
| FaxNumber: | 6108617640 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2006 | ||||||||
| LastUpdateDate: | 10/19/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208C00000X | MD059236L | PA | Y | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery |
ID Information
| ID | Type | State | Issuer | Description | 870918 | 01 | PA | DR REILLY HIGHMARK | OTHER | 0870918 | 01 | PA | DR REILLY KHP | OTHER | 01053101 | 01 | PA | DR REILLY CAPITAL BC | OTHER |