Provider Demographics
NPI:1467662635
Name:MONICA RILEY, MD
Entity Type:Organization
Organization Name:MONICA RILEY, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:LINETTE
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-448-4090
Mailing Address - Street 1:1150 VARNUM ST NE
Mailing Address - Street 2:SUITE 300, SAINT CATHERINE HALL
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2149
Mailing Address - Country:US
Mailing Address - Phone:202-448-4090
Mailing Address - Fax:202-448-4093
Practice Address - Street 1:1150 VARNUM ST NE
Practice Address - Street 2:SUITE 300, SAINT CATHERINE HALL
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2149
Practice Address - Country:US
Practice Address - Phone:202-448-4090
Practice Address - Fax:202-448-4093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD32500207Q00000X
MDD0064171207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCI19625Medicare UPIN