Healthcare Provider Details

I. General information

NPI: 1487231924
Provider Name (Legal Business Name): RILEY REID HALES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2014 WASHINGTON ST
NEWTON MA
02462-1699
US

IV. Provider business mailing address

2014 WASHINGTON ST
NEWTON MA
02462-1699
US

V. Phone/Fax

Practice location:
  • Phone: 617-243-6467
  • Fax:
Mailing address:
  • Phone: 617-243-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number1027500
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: