Provider Demographics
NPI:1528137890
Name:RILEY, LISA M (RPA C)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:RILEY
Suffix:
Gender:F
Credentials:RPA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 HAMPTON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-4848
Mailing Address - Country:US
Mailing Address - Phone:603-775-7575
Mailing Address - Fax:603-778-9680
Practice Address - Street 1:1 HAMPTON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-4848
Practice Address - Country:US
Practice Address - Phone:603-775-7575
Practice Address - Fax:603-778-9680
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY004290-1363AS0400X
NH1126363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02155457Medicaid
T400258342Medicare PIN
NYAA0798Medicare PIN
NY02155457Medicaid