Provider Demographics
NPI:1871670166
Name:RIVERA, MICHELLE A (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:A
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1635 N GEORGE MASON DRIVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205
Mailing Address - Country:US
Mailing Address - Phone:703-524-7206
Mailing Address - Fax:703-524-7245
Practice Address - Street 1:1635 N GEORGE MASON DRIVE
Practice Address - Street 2:SUITE 400
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205
Practice Address - Country:US
Practice Address - Phone:703-524-7206
Practice Address - Fax:703-524-7245
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101039759207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC173811Medicare PIN
C62267Medicare UPIN