Provider Demographics
NPI:1346414372
Name:ANNE T. RIORDAN, M.D. P.C
Entity Type:Organization
Organization Name:ANNE T. RIORDAN, M.D. P.C
Other - Org Name:WILDWOOD DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-458-8400
Mailing Address - Street 1:16516 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63040-1217
Mailing Address - Country:US
Mailing Address - Phone:636-458-8400
Mailing Address - Fax:636-458-8404
Practice Address - Street 1:16516 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:MO
Practice Address - Zip Code:63040-1217
Practice Address - Country:US
Practice Address - Phone:636-458-8400
Practice Address - Fax:636-458-8404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO105913207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000094224Medicare PIN
MOG57343Medicare UPIN