Basic Information
| Provider Information | |||||||||
| NPI: | 1538556220 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUBOIS | ||||||||
| FirstName: | RILEY | ||||||||
| MiddleName: | SEAN MAURICE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10701 ROSEMARY DR | ||||||||
| Address2: | |||||||||
| City: | MANASSAS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201097282 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7032573000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10701 ROSEMARY DR | ||||||||
| Address2: | |||||||||
| City: | MANASSAS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 20109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7032573000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2015 | ||||||||
| LastUpdateDate: | 05/27/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QA0505X | 0101264669 | VA | Y | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine |
No ID Information.