Healthcare Provider Details

I. General information

NPI: 1881776391
Provider Name (Legal Business Name): GERARD RIEDY M.D, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 01/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 ROCKVILLE PIKE
BETHESDA MD
20889-0001
US

IV. Provider business mailing address

8901 ROCKVILLE PIKE
BETHESDA MD
20889-0001
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-4000
  • Fax: 301-217-5921
Mailing address:
  • Phone: 301-295-4000
  • Fax: 301-217-5921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberD0059588
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: