Provider Demographics
NPI:1104839018
Name:RIEDER, SCOTT DAVID (DPM)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:DAVID
Last Name:RIEDER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:PA
Mailing Address - Zip Code:18517-2104
Mailing Address - Country:US
Mailing Address - Phone:570-562-1955
Mailing Address - Fax:570-562-3436
Practice Address - Street 1:1018 S MAIN ST
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:PA
Practice Address - Zip Code:18517-2104
Practice Address - Country:US
Practice Address - Phone:570-562-1955
Practice Address - Fax:570-562-3436
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC-003760L213E00000X
PASC003760L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012968300003Medicaid
PA075846OtherFIRST PRIORITY
PA0012968300003Medicaid
PARI106599Medicare ID - Type Unspecified