Provider Demographics
NPI:1710985676
Name:RIEBMAN, MICHAEL SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SCOTT
Last Name:RIEBMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1111 BENFIELD BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-3002
Mailing Address - Country:US
Mailing Address - Phone:410-729-5100
Mailing Address - Fax:410-729-5156
Practice Address - Street 1:129 LUBRANO DR
Practice Address - Street 2:SUITE 100
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7566
Practice Address - Country:US
Practice Address - Phone:410-266-5852
Practice Address - Fax:410-266-5095
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0036761207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD529270-02OtherCAREFIRST MD RENDERING
MD028700OtherJHHC PROVIDER NUMBER
MD235478OtherMAMSI SPECIALIST
MD80083144OtherRAILROAD MEDICARE
MD1580824OtherCIGNA PIN NUMBER
MD7605-0007OtherCAREFIRST BLUECHOICE
MD293441000Medicaid
MD4388551OtherAETNA FEE FOR SERVICE
MD835478OtherMAMSI PRIMARY CARE
MDP11960OtherCAREFIRST MPOS
MD0460894OtherAETNA CAPITATED
MD028700OtherJHHC PROVIDER NUMBER
MD1580824OtherCIGNA PIN NUMBER