1497073472 NPI number — MR. ALFONZA JULIUS RILEY RVS

Table of content: (NPI 1588645915)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497073472 NPI number — MR. ALFONZA JULIUS RILEY RVS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RILEY
Provider First Name:
ALFONZA
Provider Middle Name:
JULIUS
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RVS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497073472
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8162 FENWICK CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAUREL
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20707-5618
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-831-4969
Provider Business Mailing Address Fax Number:
888-831-4969

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8162 FENWICK CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAUREL
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20707-5618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-831-4969
Provider Business Practice Location Address Fax Number:
888-831-4969
Provider Enumeration Date:
05/14/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WI0500X , with the licence number:  R131048 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WI0500X , with the licence number: RN66423 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WP0000X , with the licence number: R131048 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WP0000X , with the licence number: RN66423 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2471V0105X , with the licence number: 00069902 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)