MEDICARE: MELISSA ANNE RILEY RD, LD

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	133V00000X	Registered Dietitian	D01722	MD

General Provider Information

NPI Number	:	1457139131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA ANNE RILEY RD, LD

Provider Business Mailing Address
First Line	:	6526 TWIN LAKE DR
Second Line	:
City	:	NEW MARKET
State	:	MD
Zip	:	21774-6613
Country	:	US
Telephone Number	:	240-626-6022
Fax Number	:

Provider Business Practice Location Address
First Line	:	6526 TWIN LAKE DR
Second Line	:
City	:	NEW MARKET
State	:	MD
Zip	:	21774-6613
Country	:	US
Telephone Number	:	240-626-6022
Fax Number	:

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

Provider Enumeration Date	:	09/15/2023
Last Update Date	:	09/15/2023

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