MEDICARE: MS. CHERYL ANNE RILEY PA-C

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	363AS0400X	Surgical Physician Assistant	MA-000324L	PA

General Provider Information

NPI Number	:	1518142454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHERYL ANNE RILEY PA-C

Provider Business Mailing Address
First Line	:	17 CANTER DR
Second Line	:
City	:	NEWTOWN SQUARE
State	:	PA
Zip	:	19073-2929
Country	:	US
Telephone Number	:	610-513-5959
Fax Number	:	215-955-6010

Provider Business Practice Location Address
First Line	:	1025 WALNUT ST
Second Line	:	SUITE 607
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-5001
Country	:	US
Telephone Number	:	215-955-6996
Fax Number	:	215-955-6010

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

Provider Enumeration Date	:	01/09/2008
Last Update Date	:	01/09/2008

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