Provider Demographics
NPI:1427080746
Name:RILEY, THOMAS M (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:RILEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8 APPLETON LN
Mailing Address - Street 2:
Mailing Address - City:BOXFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01921-1632
Mailing Address - Country:US
Mailing Address - Phone:978-463-1120
Mailing Address - Fax:978-463-1171
Practice Address - Street 1:25 HIGHLAND AVE
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-3867
Practice Address - Country:US
Practice Address - Phone:978-463-1120
Practice Address - Fax:978-463-1171
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA0790562085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30008649Medicaid
MA3123065Medicaid
MAJ30480Medicare ID - Type Unspecified
MA3123065Medicaid