MEDICARE: DR. NATHAN R RILES M.D.

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	0101044787	VA

General Provider Information

NPI Number	:	1659327369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATHAN R RILES M.D.

Provider Business Mailing Address
First Line	:	PO BOX 7068
Second Line	:
City	:	PORTSMOUTH
State	:	VA
Zip	:	23707-0068
Country	:	US
Telephone Number	:	757-686-3508
Fax Number	:	757-686-0541

Provider Business Practice Location Address
First Line	:	6632 INDIAN RIVER RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-3442
Country	:	US
Telephone Number	:	757-424-4442
Fax Number	:	757-523-4765

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

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	12/11/2012

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