Provider Demographics
NPI:1861472490
Name:RILEY, RALPH N (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:N
Last Name:RILEY
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 1:595 NEWBERRY HWY
Mailing Address - Street 2:PO BOX 248
Mailing Address - City:SALUDA
Mailing Address - State:SC
Mailing Address - Zip Code:29138-7808
Mailing Address - Country:US
Mailing Address - Phone:864-445-2500
Mailing Address - Fax:864-445-3956
Practice Address - Street 1:595 NEWBERRY HWY
Practice Address - Street 2:
Practice Address - City:SALUDA
Practice Address - State:SC
Practice Address - Zip Code:29138-7808
Practice Address - Country:US
Practice Address - Phone:864-445-2500
Practice Address - Fax:864-445-3956
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11521207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC115217Medicaid
SCD178995971Medicare PIN
SCD17899Medicare UPIN
SC115217Medicaid