Provider Demographics
NPI:1134141344
Name:RILEY, JOHN M (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:RILEY
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1605 N CEDAR CREST BLVD
Mailing Address - Street 2:SUITE 110B
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2351
Mailing Address - Country:US
Mailing Address - Phone:610-973-1410
Mailing Address - Fax:610-973-1449
Practice Address - Street 1:412 W MONROE ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-1717
Practice Address - Country:US
Practice Address - Phone:610-330-0464
Practice Address - Fax:484-403-4024
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2016-08-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS008329L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00150116OtherRAILROAD MEDICARE
PA001516068Medicaid
PA03218901OtherNCAS
PA2108266OtherAETNA
PA0686606OtherKEYSTONE CENTRAL
PA0000686607OtherHIGHMARK BLUE SHIELD
PA03218901OtherCAPITAL BLUE CROSS
PA0791567000OtherPERSONAL CHOICE
PA2108266OtherAETNA
PAG03533Medicare UPIN