Provider Demographics
NPI:1265647838
Name:RIEDEL, STEFAN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:STEFAN
Middle Name:
Last Name:RIEDEL
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4940 EASTERN AVE
Mailing Address - Street 2:A BUILDING, RM. 102-B
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-2735
Mailing Address - Country:US
Mailing Address - Phone:410-550-6618
Mailing Address - Fax:410-550-2109
Practice Address - Street 1:4940 EASTERN AVE
Practice Address - Street 2:A BUILDING, RM. 102-B
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-2735
Practice Address - Country:US
Practice Address - Phone:410-550-6618
Practice Address - Fax:410-550-2109
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0066607207ZC0006X, 207ZM0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology
No207ZM0300XAllopathic & Osteopathic PhysiciansPathologyMedical Microbiology