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General NPI Number Information
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NPI Number | 1174736441
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Entity Type | Individual
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Provider Name | MARY ANN RILEY D.O.
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Gender | Female
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 01/07/2015
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Provider Practice Location Address
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Address Line | 1313 NATIONAL HWY
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City | LAVALE
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State | MD
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Zip | 21502-7618
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Country | US
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Telephone | 240-362-0288
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Fax | 240-362-0052
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Provider Business Mailing Address
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Address Line | 1313 NATIONAL HWY
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City | LAVALE
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State | MD
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Zip | 21502-7618
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Country | US
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Telephone | 240-362-0288
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Fax | 240-362-0052
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 2205
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License Number State | WV
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