Healthcare Provider Details

I. General information

NPI: 1184651564
Provider Name (Legal Business Name): CONCETTA MARIA RIVA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: C. MARIA RIVA MD

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 ASHLEY AVE
CHARLESTON SC
29425-8908
US

IV. Provider business mailing address

PO BOX 751461
CHARLOTTE NC
28275-1461
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-1414
  • Fax:
Mailing address:
  • Phone: 843-792-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0422724
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number0422724
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number35438
License Number StateSC
# 4
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number35438
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: