Provider Demographics
NPI:1184651564
Name:RIVA, CONCETTA MARIA (MD)
Entity Type:Individual
Prefix:
First Name:CONCETTA
Middle Name:MARIA
Last Name:RIVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:C. MARIA
Other - Middle Name:
Other - Last Name:RIVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 751461
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1461
Mailing Address - Country:US
Mailing Address - Phone:843-792-6200
Mailing Address - Fax:
Practice Address - Street 1:171 ASHLEY AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-8908
Practice Address - Country:US
Practice Address - Phone:843-792-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0422724208000000X, 2080P0214X
SC354382084S0012X, 2080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS105852OtherBCBS OF KANSAS
KS100179590DMedicaid
KS100179590CMedicaid
KS106582OtherBCBS
KS106582Medicare PIN
KS105852Medicare ID - Type Unspecified
KS105852OtherBCBS OF KANSAS