Provider Demographics
NPI:1306998281
Name:RILEY, JAMES NELSON SR (DO)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:NELSON
Last Name:RILEY
Suffix:SR
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:371 S MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-2351
Mailing Address - Country:US
Mailing Address - Phone:207-200-1907
Mailing Address - Fax:207-989-0970
Practice Address - Street 1:86 DAVIS RD
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-2311
Practice Address - Country:US
Practice Address - Phone:207-992-2205
Practice Address - Fax:207-992-2207
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2015-12-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ME1170204D00000X, 204D00000X
ME1170 DO207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME123700099Medicaid
MED93059Medicare UPIN
MM108801Medicare PIN
MM1088Medicare PIN
D93059Medicare UPIN