Provider Demographics
NPI:1568514313
Name:JAMES N. RILEY, D.O., P.A.
Entity Type:Organization
Organization Name:JAMES N. RILEY, D.O., P.A.
Other - Org Name:EAST BANK HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:N
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:SR
Authorized Official - Credentials:DO
Authorized Official - Phone:207-989-1567
Mailing Address - Street 1:451 SOUTH MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-2326
Mailing Address - Country:US
Mailing Address - Phone:207-989-1567
Mailing Address - Fax:207-989-6889
Practice Address - Street 1:451 SOUTH MAIN ST
Practice Address - Street 2:
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-2326
Practice Address - Country:US
Practice Address - Phone:207-989-1567
Practice Address - Fax:207-989-6889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1170204D00000X, 207Q00000X
ME016622207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM4145Medicare ID - Type Unspecified