Provider Demographics
NPI:1831503549
Name:RILEY, JULIE (DPM)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:RILEY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 POND ST STE 3
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-6853
Mailing Address - Country:US
Mailing Address - Phone:781-848-9978
Mailing Address - Fax:781-848-7773
Practice Address - Street 1:409 POND ST STE 3
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-6853
Practice Address - Country:US
Practice Address - Phone:781-848-9978
Practice Address - Fax:781-848-7773
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-20
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2461213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery