Organization
OLD FASHION MEDICINE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN ALLEN REILLY MD (OWNER/PHYSICIAN)
(240) 409-3348
Entity
Organization
Contact information
Practice address
95 GATEPOST LANE, APARTMENT 1B, FREDERICK, MD 21701
(240) 409-3348
Mailing address
16722 ANNANDALE RD, EMMITSBURG, MD 21727-8908
(240) 888-5023
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
D0054749
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2853027000
—
MD
Enumeration date
03/28/2018
Last updated
06/21/2018
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