1750919163 NPI number — CHRISTOPHER RILEY DO

Table of content: CHRISTOPHER RILEY DO (NPI 1750919163)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750919163 NPI number — CHRISTOPHER RILEY DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RILEY
Provider First Name:
CHRISTOPHER
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1750919163
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ATTN: GME COORDINATOR, 88 MEDICAL GROUP (MDG)
Provider Second Line Business Mailing Address:
4881 SUGAR MAPLE DRIVE
Provider Business Mailing Address City Name:
WRIGHT-PATTERSON AIR FORCE BASE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45433
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-257-0837
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4881 SUGAR MAPLE DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WRIGHT-PATTERSON AIR FORCE BASE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-296-3963
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/31/2020

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 171000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2025 www.npivalidator.com