Provider Demographics
NPI:1194950444
Name:RILEY, JASON PAUL (DO)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:PAUL
Last Name:RILEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:12234 WILLIAMS RD SE
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-7960
Mailing Address - Country:US
Mailing Address - Phone:301-727-0132
Mailing Address - Fax:301-759-5874
Practice Address - Street 1:12234 WILLIAMS RD SE
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-7960
Practice Address - Country:US
Practice Address - Phone:301-727-0132
Practice Address - Fax:301-759-5874
Is Sole Proprietor?:No
Enumeration Date:2009-05-15
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0077584208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology