Provider Demographics
NPI:1831779065
Name:RIDER, EMILY KATHERINE
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:KATHERINE
Last Name:RIDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12576 WINFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:25213-7315
Mailing Address - Country:US
Mailing Address - Phone:304-586-0112
Mailing Address - Fax:304-586-0114
Practice Address - Street 1:12576 WINFIELD RD
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:WV
Practice Address - Zip Code:25213-7315
Practice Address - Country:US
Practice Address - Phone:304-586-0112
Practice Address - Fax:304-586-0114
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV4295207Q00000X
WV390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program