Provider Demographics
NPI:1578661880
Name:RIEDER, NANCY BARBARA (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:BARBARA
Last Name:RIEDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:763 JOHNSONBURG ROAD
Mailing Address - Street 2:
Mailing Address - City:ST. MARYS
Mailing Address - State:PA
Mailing Address - Zip Code:15857
Mailing Address - Country:US
Mailing Address - Phone:814-834-4399
Mailing Address - Fax:814-788-8092
Practice Address - Street 1:761 JOHNSONBURG ROAD
Practice Address - Street 2:SUITE 160
Practice Address - City:ST. MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857
Practice Address - Country:US
Practice Address - Phone:814-834-4399
Practice Address - Fax:814-788-8092
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101240588208000000X
PAMD041387L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012043370004Medicaid
VAB56581Medicare UPIN
B56581Medicare UPIN
VA011097P95Medicare PIN