Provider Demographics
NPI:1316585615
Name:RILEY, BRENDAN WILLIAM
Entity type:Individual
Prefix:
First Name:BRENDAN
Middle Name:WILLIAM
Last Name:RILEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 KEVINS WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02375-1299
Mailing Address - Country:US
Mailing Address - Phone:508-915-0520
Mailing Address - Fax:
Practice Address - Street 1:88 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-2499
Practice Address - Country:US
Practice Address - Phone:508-828-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-17
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant