Provider Demographics
NPI:1104845981
Name:RILEY, CHARLES A (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:A
Last Name:RILEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 9TH ST N STE 310
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5889
Mailing Address - Country:US
Mailing Address - Phone:239-624-8250
Mailing Address - Fax:239-624-8251
Practice Address - Street 1:311 9TH ST N STE 310
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5889
Practice Address - Country:US
Practice Address - Phone:239-624-8250
Practice Address - Fax:239-624-8251
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME131211207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022056000Medicaid
FLJC606ZOtherMEDICARE
AZ132051Medicaid
FLIOWCJOtherBCBS