Provider Demographics
NPI:1598280273
Name:RIEDEL, COURTNEY GRAY (RD)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:GRAY
Last Name:RIEDEL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15229-1260
Mailing Address - Country:US
Mailing Address - Phone:412-350-9165
Mailing Address - Fax:
Practice Address - Street 1:815 FREEPORT RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15215-3301
Practice Address - Country:US
Practice Address - Phone:412-784-5528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN006237133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered