Provider Demographics
NPI:1447435672
Name:RILEY, ALAN FREDERICK KEOHANE (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:FREDERICK KEOHANE
Last Name:RILEY
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 1:71 US ROUTE 1 STE C
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-7174
Mailing Address - Country:US
Mailing Address - Phone:207-883-5532
Mailing Address - Fax:
Practice Address - Street 1:71 US ROUTE 1 STE C
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-7174
Practice Address - Country:US
Practice Address - Phone:207-883-5532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY254076208000000X
TXP70262080P0202X
390200000X
MEMD281772080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX319689107 (MDACC)Medicaid
TX296091YKQH (MDACC)Medicare PIN