Provider Demographics
NPI:1093877573
Name:RILEY, MICHAEL P (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:RILEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3400 SPRUCE ST
Mailing Address - Street 2:9 FOUNDERS
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4206
Mailing Address - Country:US
Mailing Address - Phone:215-662-4212
Mailing Address - Fax:215-615-5441
Practice Address - Street 1:3400 SPRUCE ST
Practice Address - Street 2:9 FOUNDERS
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4206
Practice Address - Country:US
Practice Address - Phone:215-662-4212
Practice Address - Fax:215-615-5441
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2012-02-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD424303207RC0001X
NJ25MA08471000207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD 424303OtherPENNSYLVANIA MEDICAL LICENSE
NJ25MA08471000OtherNEW JERSEY MEDICAL LICENSE