Provider Demographics
NPI:1700828878
Name:RIEBEL, GREGORY DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:DAVID
Last Name:RIEBEL
Suffix:
Gender:M
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:PO BOX 8310
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-0310
Mailing Address - Country:US
Mailing Address - Phone:540-345-3556
Mailing Address - Fax:540-777-1147
Practice Address - Street 1:101 KNOTBREAK RD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-5404
Practice Address - Country:US
Practice Address - Phone:540-444-4020
Practice Address - Fax:540-444-4021
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057389207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA700201860OtherCIGNA
VA4503802OtherAETNA
VA200040421OtherRAILROAD MEDICARE
VA542006922OtherUNITED HEALTHCARE
VA3933260001OtherADMINISTAR FEDERAL
VA452547OtherANTHEM
VA127777OtherSOUTHERN HEALTH
VA286128OtherMAMSI
VA006401121Medicaid
VA542006922OtherUNITED HEALTHCARE
VA3933260001OtherADMINISTAR FEDERAL