Provider Demographics
NPI:1326098955
Name:RILEY, P. THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:P.
Middle Name:THOMAS
Last Name:RILEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1301 COLLEGE AVE
Mailing Address - Street 2:UNIVERSITY OF MARY WASHINGTON
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-5300
Mailing Address - Country:US
Mailing Address - Phone:540-654-1040
Mailing Address - Fax:540-654-1077
Practice Address - Street 1:1301 COLLEGE AVE
Practice Address - Street 2:UNIVERSITY OF MARY WASHINGTON
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-5300
Practice Address - Country:US
Practice Address - Phone:540-654-1040
Practice Address - Fax:540-654-1077
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101028442207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA540883363OtherPREFERRED CARE
VA540883363OtherCHAMPUS-TRICARE
VA10490OtherCIGNA
VA52955OtherOPTIMA
VA540883363OtherGREAT WEST HEALTHCARE
VA540883363OtherVIRGINIA HEALTH NETWORK
VA856726OtherMAMSI
VA116049OtherANTHEM
VA856726OtherRAILROAD MEDICARE
VA0100420OtherUNTIED HEALTHCARE
VA540189OtherAETNA
VA540883363OtherFIRST HEALTH/CCN
VA5633826Medicaid
VA82539OtherSOUTHERN HEALTH
VA540883363OtherPHCS
VA82539OtherSOUTHERN HEALTH
VA5633826Medicaid