Provider Demographics
NPI:1679634703
Name:RIVERA, MARIA P (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:P
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE BOX MED
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-486-0147
Mailing Address - Fax:
Practice Address - Street 1:400 RED CREEK DR STE 110
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-4273
Practice Address - Country:US
Practice Address - Phone:585-486-0147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC009300789207RP1001X
NY169769207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC010052216OtherRAIL ROAD MEDICARE
NC8971664Medicaid
NC010052216OtherRAIL ROAD MEDICARE
NCF25851Medicare UPIN