Provider Demographics
NPI:1003259771
Name:VIRGINIA BEHAVIORAL MEDICINE PLLC
Entity Type:Organization
Organization Name:VIRGINIA BEHAVIORAL MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:RIEDLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-373-0380
Mailing Address - Street 1:1301 FIRST COLONIAL RD
Mailing Address - Street 2:STE 200
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-2263
Mailing Address - Country:US
Mailing Address - Phone:757-222-1230
Mailing Address - Fax:757-222-1887
Practice Address - Street 1:1301 FIRST COLONIAL RD
Practice Address - Street 2:STE 200
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-2263
Practice Address - Country:US
Practice Address - Phone:757-222-1230
Practice Address - Fax:757-222-1887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-12
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101054894323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA260051194OtherRAILROAD MEDICARE
VA007117817Medicaid
VA260003122Medicare PIN
VA007117817Medicaid