Provider Demographics
NPI:1487810750
Name:RILEY, TRAM CAO (PA)
Entity type:Individual
Prefix:MISS
First Name:TRAM
Middle Name:CAO
Last Name:RILEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:TRAM
Other - Middle Name:
Other - Last Name:CAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2000 WASHINGTON ST.
Mailing Address - Street 2:SUITE 444-WHITE BUILDING
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02462
Mailing Address - Country:US
Mailing Address - Phone:617-244-0990
Mailing Address - Fax:617-969-4044
Practice Address - Street 1:2000 WASHINGTON ST.
Practice Address - Street 2:SUITE 444-WHITE BUILDING
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462
Practice Address - Country:US
Practice Address - Phone:617-244-0990
Practice Address - Fax:617-969-4044
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAP2578363AS0400X
PA2578363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical