Healthcare Provider Details

I. General information

NPI: 1265441760
Provider Name (Legal Business Name): VICTORIA LYNN RILEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BLYTHE BLVD
CHARLOTTE NC
28203-5812
US

IV. Provider business mailing address

6943 WINNERS CIR
LAKEWOOD RANCH FL
34202-2422
US

V. Phone/Fax

Practice location:
  • Phone: 704-381-2000
  • Fax:
Mailing address:
  • Phone: 813-719-5309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME89026
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME89026
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number2025-01031
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: