Provider Demographics
NPI:1922638295
Name:RILEY, GREGORY PITTMAN
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:PITTMAN
Last Name:RILEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2928 SOUTHERN AVE SE APT 1
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-1728
Mailing Address - Country:US
Mailing Address - Phone:202-227-1753
Mailing Address - Fax:
Practice Address - Street 1:2928 SOUTHERN AVE SE APT 1
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-1728
Practice Address - Country:US
Practice Address - Phone:202-227-1753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant