Provider Demographics
NPI:1861454597
Name:RILL, MICHAEL P (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:P
Last Name:RILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:61 JACQUELINE CIR
Mailing Address - Street 2:
Mailing Address - City:GLENMOORE
Mailing Address - State:PA
Mailing Address - Zip Code:19343-1715
Mailing Address - Country:US
Mailing Address - Phone:610-942-0303
Mailing Address - Fax:610-942-0303
Practice Address - Street 1:61 JACQUELINE CIR
Practice Address - Street 2:
Practice Address - City:GLENMOORE
Practice Address - State:PA
Practice Address - Zip Code:19343-1715
Practice Address - Country:US
Practice Address - Phone:610-942-0303
Practice Address - Fax:610-942-0303
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041931E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001133576Medicaid
PA010034426OtherRAILROAD MEDICARE PTAN
B41598Medicare UPIN
PA001133576Medicaid