Provider Demographics
NPI:1801037221
Name:RIESE, RICHARD JUDE (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:JUDE
Last Name:RIESE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 CHESTNUT PL
Mailing Address - Street 2:APARTMENT 614
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7565
Mailing Address - Country:US
Mailing Address - Phone:617-566-5516
Mailing Address - Fax:
Practice Address - Street 1:22 CHESTNUT PL
Practice Address - Street 2:APARTMENT 614
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7565
Practice Address - Country:US
Practice Address - Phone:617-566-5516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-14
Last Update Date:2009-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA80376207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine