Provider Demographics
NPI:1275635658
Name:RIEDER, ROBERT SCOTT (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:SCOTT
Last Name:RIEDER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:S
Other - Last Name:RIEDERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
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:410-510-1244
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:410-510-1244
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDO1116213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD01116OtherPODIATRY LICENSE
MD0949110001OtherDME
MDT325RSMedicare ID - Type Unspecified
MDU21674Medicare UPIN