MEDICARE: NICHOLAS JOHN RIESLAND MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD00019113	WA

General Provider Information

NPI Number	:	1063482784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS JOHN RIESLAND MD

Provider Business Mailing Address
First Line	:	UNIT 8400 BOX 2
Second Line	:
City	:	FPO
State	:	AE
Zip	:	09498-4007
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2401 E STREET NW
Second Line	:	OFFICE OF MEDICAL SERVICES, US DEPARTMENT OF STATE
City	:	WASHINGTON
State	:	DC
Zip	:	20522-0102
Country	:	US
Telephone Number	:	202-663-1649
Fax Number	:	202-663-1613

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	07/21/2022

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