Provider Demographics
NPI:1922395490
Name:RILEY, MATTHEW H (DO)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:H
Last Name:RILEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:450 STANYAN ST.
Mailing Address - Street 2:ROOM 503
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117
Mailing Address - Country:US
Mailing Address - Phone:415-750-5909
Mailing Address - Fax:415-750-5910
Practice Address - Street 1:450 STANYAN ST.
Practice Address - Street 2:ROOM 503
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117
Practice Address - Country:US
Practice Address - Phone:415-750-5909
Practice Address - Fax:415-750-5910
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A13448207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILRES000Medicare UPIN