Provider Demographics
NPI:1376509471
Name:RIAZ, ROSELINE (MD)
Entity Type:Individual
Prefix:
First Name:ROSELINE
Middle Name:
Last Name:RIAZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:FREELAND
Mailing Address - State:PA
Mailing Address - Zip Code:18224-1805
Mailing Address - Country:US
Mailing Address - Phone:570-636-1556
Mailing Address - Fax:570-636-0985
Practice Address - Street 1:404 RIDGE ST
Practice Address - Street 2:
Practice Address - City:FREELAND
Practice Address - State:PA
Practice Address - Zip Code:18224-1805
Practice Address - Country:US
Practice Address - Phone:570-636-1556
Practice Address - Fax:570-636-0985
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD065583L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G79034Medicare UPIN
NYRA1190Medicare ID - Type Unspecified
NY00026169402OtherUNIVERA LEGACY#
G79034Medicare UPIN
NY2590189OtherGHI LEGACY#
NY8494418Medicaid
NY000527215002OtherHEALTH NOW BCBS LEGACY#
NY0492679OtherIHA LEGACY#
NY159952BJOtherPREFERRED CARE LEGACY#