Provider Demographics
NPI:1174633804
Name:MICHELLE A. RIVERA MD PC
Entity Type:Organization
Organization Name:MICHELLE A. RIVERA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:RIVERIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-524-7206
Mailing Address - Street 1:1635 N GEORGE MASON DRIVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205
Mailing Address - Country:US
Mailing Address - Phone:703-524-7206
Mailing Address - Fax:703-524-7245
Practice Address - Street 1:1635 N GEORGE MASON DRIVE
Practice Address - Street 2:SUITE 400
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205
Practice Address - Country:US
Practice Address - Phone:703-524-7206
Practice Address - Fax:703-524-7245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101039759207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC173811Medicare PIN
C62267Medicare UPIN