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Individual

DR. KIM MARIE REILLY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
1011 ROCK QUARRY RD, RALEIGH, NC 27610-3825
(984) 464-6749
Mailing address
1011 ROCK QUARRY RD, RALEIGH, NC 27610-3825
(984) 464-6749

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
2021-01611
NC
208000000X
Pediatrics Physician
35078399R
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000177532
UNISON PIN
OH
01
000000185154
ANTHEM PIN
OH
01
0989499
GROUP MEDICAID
OH
01
1204464
UHC PIN
OH
05
2189911
OH
01
311413469053
CARESOURCE PIN
OH
01
RE4028581
MEDICARE PTAN
Enumeration date
12/14/2005
Last updated
01/13/2023
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