Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0001X | Clinical Cardiac Electrophysiologist | 25MA08471000 | NJ |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | MD424303 | PA |
NPI | 1093877573 |
---|---|
Provider Name | Michael P Riley |
First Address | Philadelphia, PA 19104-4206 |
Second Address | Philadelphia, PA 19104-4206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2006 |
Last Update Date | 09/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
25MA08471000 | NEW JERSEY MEDICAL LICENSE (01) | NJ |
MD 424303 | PENNSYLVANIA MEDICAL LICENSE (01) | PA |