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General NPI Number Information
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NPI Number | 1174615587
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Entity Type | Individual
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Provider Name | BRIAN RIEDEL MD
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Gender | Male
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Dates
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Enumeration Date | 09/30/2006
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Last Update Date | 04/13/2022
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Provider Practice Location Address
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Address Line | 1 MEDICAL CENTER DR POC PEDIATRIC CLINIC
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City | MORGANTOWN
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State | WV
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Zip | 26506
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Country | US
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Telephone | 304-293-1017
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Fax | 304-293-4337
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Provider Business Mailing Address
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Address Line | 1 MEDICAL CENTER DR PO BOX 9214
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City | MORGANTOWN
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State | WV
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Zip | 26506-9214
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Country | US
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Telephone | 304-293-1017
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Fax | 304-293-4337
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0206X
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Taxonomy Name | Pediatric Gastroenterology Physician
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License Number | 23973
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License Number State | WV
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