Provider Demographics
NPI:1285936476
Name:CHARLES P. RILEY MD PA
Entity type:Organization
Organization Name:CHARLES P. RILEY MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:L
Authorized Official - Last Name:CARNLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-477-4342
Mailing Address - Street 1:1549 AIRPORT BLVD
Mailing Address - Street 2:SUITE 410
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8633
Mailing Address - Country:US
Mailing Address - Phone:850-477-4342
Mailing Address - Fax:850-477-7194
Practice Address - Street 1:1549 AIRPORT BLVD
Practice Address - Street 2:SUITE 410
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8633
Practice Address - Country:US
Practice Address - Phone:850-477-4342
Practice Address - Fax:850-477-7194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-22
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty