Healthcare Provider Details

I. General information

NPI: 1104001619
Provider Name (Legal Business Name): DR. ROBERT SCOTT RIEDER D.P.M.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2008
Last Update Date: 02/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9515 HARFORD RD
BALTIMORE MD
21234-3124
US

IV. Provider business mailing address

12 QUELET PL
NOTTINGHAM MD
21236-1551
US

V. Phone/Fax

Practice location:
  • Phone: 410-668-7007
  • Fax:
Mailing address:
  • Phone: 443-413-5640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number01116
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number01116
License Number StateMD

VIII. Authorized Official

Name: DR. ROBERT SCOTT RIEDER
Title or Position: DOCTOR OF PODIATRIC MEDICINE
Credential: DPM
Phone: 443-413-5640