MEDICARE: CRYSTAL RILEY PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	0010-05657	NC
2	363A00000X	Physician Assistant	C0005716	MD

General Provider Information

NPI Number	:	1578957585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL RILEY PA-C

Provider Business Mailing Address
First Line	:	193 STONER AVE STE 300
Second Line	:
City	:	WESTMINSTER
State	:	MD
Zip	:	21157-5588
Country	:	US
Telephone Number	:	410-871-2204
Fax Number	:	410-871-2207

Provider Business Practice Location Address
First Line	:	193 STONER AVE STE 300
Second Line	:
City	:	WESTMINSTER
State	:	MD
Zip	:	21157-5588
Country	:	US
Telephone Number	:	410-871-2204
Fax Number	:	410-871-2207

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2015
Last Update Date	:	02/26/2024

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Directions to “ CRYSTAL RILEY PA-C” Practice Location

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