Provider Demographics
NPI:1659327369
Name:RILES, NATHAN R (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:R
Last Name:RILES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 7068
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-0068
Mailing Address - Country:US
Mailing Address - Phone:757-686-3508
Mailing Address - Fax:757-686-0541
Practice Address - Street 1:6632 INDIAN RIVER RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-3442
Practice Address - Country:US
Practice Address - Phone:757-424-4442
Practice Address - Fax:757-523-4765
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2012-12-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101044787207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAE60365Medicare UPIN