Provider Demographics
NPI:1669447694
Name:RIVERA, MARIA E (DO)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:E
Last Name:RIVERA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 GOSHEN RD
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326-5545
Mailing Address - Country:US
Mailing Address - Phone:912-826-6000
Mailing Address - Fax:912-826-6016
Practice Address - Street 1:100 GOSHEN RD
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326
Practice Address - Country:US
Practice Address - Phone:912-826-6000
Practice Address - Fax:912-826-6016
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY231623-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAI07281Medicare UPIN
08BCBFGMedicare ID - Type Unspecified