Individual
BRENT M REILLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2800 MAIN ST, ST.VINCENTS MULTISPECIALTY GROUP, BRIDGEPORT, CT 06606-4201
(203) 576-6000
Mailing address
6 LAUREL GLEN DR, SHELTON, CT 06484-3651
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
001824
CT
363AS0400X
Surgical Physician Assistant
Primary
001824
CT
Other
Enumeration date
11/20/2006
Last updated
09/29/2014
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