Healthcare Provider Details

I. General information

NPI: 1760829915
Provider Name (Legal Business Name): MATTHEW D RIEDEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2013
Last Update Date: 05/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 YORK ST
NEW HAVEN CT
06510-3220
US

IV. Provider business mailing address

800 HOWARD AVE FL 1
NEW HAVEN CT
06519-1369
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-4949
  • Fax:
Mailing address:
  • Phone: 203-785-4949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberL-255283
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number62967
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: