Provider Demographics
NPI:1669474938
Name:RIFFLE, GREGORY CLELL (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:CLELL
Last Name:RIFFLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8140 NORTON PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-6017
Mailing Address - Country:US
Mailing Address - Phone:440-255-1115
Mailing Address - Fax:440-255-1550
Practice Address - Street 1:8140 NORTON PKWY STE 110
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-6017
Practice Address - Country:US
Practice Address - Phone:440-255-1115
Practice Address - Fax:440-255-1550
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-2489-R207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000126784OtherANTHEM
OH1240023OtherUNITED HEALTH CARE
104703OtherKAISER
OH180010464OtherRAILROAD MEDICARE
OH34158OtherHEALTH DESIGN
OH000000126784OtherANTHEM
OH34158OtherHEALTH DESIGN
OH0235710001Medicare NSC
OHLO464591Medicare ID - Type UnspecifiedOHIO JOB & FAMILY