Provider Demographics
NPI:1417213125
Name:RIVIELLO, MICHAEL SAMUEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SAMUEL
Last Name:RIVIELLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 TULLAMORE DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-7065
Mailing Address - Country:US
Mailing Address - Phone:610-793-9708
Mailing Address - Fax:
Practice Address - Street 1:1 TULLAMORE DR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-7065
Practice Address - Country:US
Practice Address - Phone:610-793-9708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-06
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD008527E2083X0100X
DEC1-00024612083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine