Healthcare Provider Details

I. General information

NPI: 1366414104
Provider Name (Legal Business Name): JOHN FLORIAN RIEDLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 04/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 VIKING DR SUITE 200
VIRGINIA BEACH VA
23452-7477
US

IV. Provider business mailing address

500 VIKING DR SUITE 200
VIRGINIA BEACH VA
23452-7477
US

V. Phone/Fax

Practice location:
  • Phone: 757-468-0550
  • Fax: 757-468-9992
Mailing address:
  • Phone: 757-468-0550
  • Fax: 757-468-9992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number15053
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101054894
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number21876
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number13743
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: