Provider Demographics
NPI:1104001619
Name:DR. ROBERT SCOTT RIEDER D.P.M.
Entity Type:Organization
Organization Name:DR. ROBERT SCOTT RIEDER D.P.M.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PODIATRIC MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:RIEDER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:443-413-5640
Mailing Address - Street 1:12 QUELET PL
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-1551
Mailing Address - Country:US
Mailing Address - Phone:443-413-5640
Mailing Address - Fax:
Practice Address - Street 1:9515 HARFORD RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-3124
Practice Address - Country:US
Practice Address - Phone:410-668-7007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01116332BC3200X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU21674Medicare UPIN
MD0949110001Medicare NSC