Provider Demographics
NPI:1699062612
Name:RIVERA, WILHEM (MD)
Entity type:Individual
Prefix:DR
First Name:WILHEM
Middle Name:
Last Name:RIVERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 3RD ST SW APT 106
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20024-4405
Mailing Address - Country:US
Mailing Address - Phone:717-851-2345
Mailing Address - Fax:717-851-4513
Practice Address - Street 1:500 INDIANA AVE NW STE 1230
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-2131
Practice Address - Country:US
Practice Address - Phone:202-879-0220
Practice Address - Fax:202-879-1618
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT200509208600000X
DCMD0431852084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No208600000XAllopathic & Osteopathic PhysiciansSurgery