Individual
THERESA KORNELUK REILLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2418 E ALLEGHENY AVE, PHILADELPHIA, PA 19134-4403
(215) 634-6660
(215) 739-6777
Mailing address
2418 E ALLEGHENY AVE, PHILADELPHIA, PA 19134-4403
(215) 634-6660
(215) 739-6777
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
020803E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0842013
—
PA
Enumeration date
06/10/2006
Last updated
06/09/2010
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