Provider Demographics
NPI:1720844160
Name:RILAND, MADISON
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:RILAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 BLUE RIDGE DR APT 12301
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-1586
Mailing Address - Country:US
Mailing Address - Phone:512-922-8420
Mailing Address - Fax:
Practice Address - Street 1:1501 BLUE RIDGE DR APT 12301
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-1586
Practice Address - Country:US
Practice Address - Phone:512-922-8420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant