Healthcare Provider Details

I. General information

NPI: 1255397519
Provider Name (Legal Business Name): JEFFREY STEWART RIEDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 05/24/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 SAINT ANDREWS BLVD
CHARLESTON SC
29407-7156
US

IV. Provider business mailing address

PO BOX 751649
CHARLOTTE NC
28275-1649
US

V. Phone/Fax

Practice location:
  • Phone: 843-723-6111
  • Fax: 843-723-0675
Mailing address:
  • Phone: 843-789-1620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number17242
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: