1366414104 NPI number — DR. JOHN FLORIAN RIEDLER MD

Table of content: EMILY KARINA TUCK (NPI 1750143640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366414104 NPI number — DR. JOHN FLORIAN RIEDLER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIEDLER
Provider First Name:
JOHN
Provider Middle Name:
FLORIAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366414104
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 VIKING DR
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23452-7477
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-468-0550
Provider Business Mailing Address Fax Number:
757-468-9992

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 VIKING DR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
VIRGINIA BEACH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23452-7477
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-468-0550
Provider Business Practice Location Address Fax Number:
757-468-9992
Provider Enumeration Date:
02/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084A0401X , with the licence number:  15053 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: 0101054894 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0804X , with the licence number: 21876 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0804X , with the licence number: 13743 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 260051194 . This is a "MCARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 292381 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 007117817 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 16338 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 243512 . This is a "MANAGED HEALTH NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: C01884 . This is a "MCARE GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 089431 . This is a "SENTARA OPTIMA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 121837 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 362206 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 292381 . This is a "ANTHEM PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2005218 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 292381 . This is a "ANTHEM HEALTH KEEPERS" identifier . This identifiers is of the category "OTHER".




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