Healthcare Provider Details

I. General information

NPI: 1326098955
Provider Name (Legal Business Name): P. THOMAS RILEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 11/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 COLLEGE AVE UNIVERSITY OF MARY WASHINGTON
FREDERICKSBURG VA
22401-5300
US

IV. Provider business mailing address

1301 COLLEGE AVE UNIVERSITY OF MARY WASHINGTON
FREDERICKSBURG VA
22401-5300
US

V. Phone/Fax

Practice location:
  • Phone: 540-654-1040
  • Fax: 540-654-1077
Mailing address:
  • Phone: 540-654-1040
  • Fax: 540-654-1077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101028442
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: