Provider Demographics
NPI:1629066923
Name:RIEDEL, CHARLES WILLIAM (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:WILLIAM
Last Name:RIEDEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 W HAMILTON ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-6470
Mailing Address - Country:US
Mailing Address - Phone:610-432-4665
Mailing Address - Fax:610-432-8512
Practice Address - Street 1:1941 W HAMILTON ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-6470
Practice Address - Country:US
Practice Address - Phone:610-432-4665
Practice Address - Fax:610-432-8512
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009291L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA026537OtherMEDICARE GROUP B
PA0017558430005Medicaid
PA0017558430005Medicaid