Provider Demographics
NPI:1659766541
Name:RILEY, RAYMOND (PA-C)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:
Last Name:RILEY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209C DEFENSE HWY
Mailing Address - Street 2:APT. N
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-2403
Mailing Address - Country:US
Mailing Address - Phone:443-332-4260
Mailing Address - Fax:888-721-8040
Practice Address - Street 1:550 WHITE OAK ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-4710
Practice Address - Country:US
Practice Address - Phone:336-625-1360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-05662363A00000X
MDC05750363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant