Provider Demographics
NPI:1174615587
Name:RIEDEL, BRIAN (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:RIEDEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:PO BOX 9214
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26506-9214
Mailing Address - Country:US
Mailing Address - Phone:304-293-1017
Mailing Address - Fax:304-293-4337
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:POC PEDIATRIC CLINIC
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26506
Practice Address - Country:US
Practice Address - Phone:304-293-1017
Practice Address - Fax:304-293-4337
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2022-04-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WV239732080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E04242Medicare UPIN