Provider Demographics
NPI:1174718456
Name:REILLY, GAYATRI (MD)
Entity type:Individual
Prefix:
First Name:GAYATRI
Middle Name:
Last Name:REILLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7501 GREENWAY CENTER DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3514
Mailing Address - Country:US
Mailing Address - Phone:301-474-4679
Mailing Address - Fax:
Practice Address - Street 1:5454 WISCONSIN AVE STE 650
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-6956
Practice Address - Country:US
Practice Address - Phone:301-656-8100
Practice Address - Fax:301-652-2957
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD039183207WX0107X, 207W00000X
VA0101249358207WX0107X
MDD0071930207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1174718456Medicaid
DC041285100Medicaid
MD590023900Medicaid