Healthcare Provider Details

I. General information

NPI: 1659413094
Provider Name (Legal Business Name): SCOTT VARNES RIDDELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 03/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12065 OLD MERIDIAN ST STE 100
CARMEL IN
46032
US

IV. Provider business mailing address

12065 OLD MERIDIAN ST STE 100
CARMEL IN
46032-5376
US

V. Phone/Fax

Practice location:
  • Phone: 317-844-5351
  • Fax: 317-844-0310
Mailing address:
  • Phone: 317-844-5351
  • Fax: 317-844-0310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01037635
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: