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General NPI Number Information
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NPI Number | 1902141104
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Entity Type | Individual
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Provider Name | ANNA MARIA RIES P.A.
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Gender | Female
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Dates
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Enumeration Date | 11/29/2012
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 1930 S BROAD ST UNIT 11
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City | PHILADELPHIA
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State | PA
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Zip | 19145-2328
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Country | US
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Telephone | 267-758-2460
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Fax |
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Provider Business Mailing Address
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Address Line | 1930 S BROAD ST UNIT 11
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City | PHILADELPHIA
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State | PA
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Zip | 19145-2328
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Country | US
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Telephone |
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA055975
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601006520
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License Number State | MI
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