Provider Demographics
NPI:1215069000
Name:RILEY, MATTHEW TRAVIS (PA-C)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:TRAVIS
Last Name:RILEY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2644 CHRONISTER FARM ROAD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402
Mailing Address - Country:US
Mailing Address - Phone:717-245-3400
Mailing Address - Fax:
Practice Address - Street 1:1120 PIKE STREET
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:16652
Practice Address - Country:US
Practice Address - Phone:717-245-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA-889363A00000X
PAMA055937363A00000X
NC103339363A00000X
PAOA003428363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant