Individual
MICHELE QUINTANA REILLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
20955 PROFESSIONAL PLZ, STE 200, ASHBURN, VA 20147-3405
(703) 729-7652
(703) 729-8746
Mailing address
PO BOX 17334, BALTIMORE, MD 21297-1334
(703) 443-6717
(703) 443-8643
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0102037069
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
370016509
RR MEDICARE
—
05
—
6704549
—
VA
Enumeration date
08/31/2005
Last updated
03/15/2011
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