Healthcare Provider Details

I. General information

NPI: 1447134341
Provider Name (Legal Business Name): PAUL RIVAS MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7801 YORK RD STE 305
TOWSON MD
21204-7449
US

IV. Provider business mailing address

7801 YORK RD STE 305
TOWSON MD
21204-7449
US

V. Phone/Fax

Practice location:
  • Phone: 410-583-5677
  • Fax: 410-583-5680
Mailing address:
  • Phone: 410-583-5677
  • Fax: 410-583-5680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ELI LUFT
Title or Position: COO
Credential: PHYSICIAN ASSISTANT
Phone: 786-203-0075