Provider Demographics
NPI:1528635802
Name:EWEN, RILEY
Entity type:Individual
Prefix:
First Name:RILEY
Middle Name:
Last Name:EWEN
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 1:106 PARK DR
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:VA
Mailing Address - Zip Code:24445-2921
Mailing Address - Country:US
Mailing Address - Phone:540-839-7000
Mailing Address - Fax:
Practice Address - Street 1:106 PARK DR
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:VA
Practice Address - Zip Code:24445-2921
Practice Address - Country:US
Practice Address - Phone:540-839-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102208500207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine