Provider Demographics
NPI:1952370108
Name:RIFFELL, DOUGLAS A (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:A
Last Name:RIFFELL
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 1:5735 MEEKER RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45331-1180
Mailing Address - Country:US
Mailing Address - Phone:937-548-3806
Mailing Address - Fax:937-548-3552
Practice Address - Street 1:702 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ARCANUM
Practice Address - State:OH
Practice Address - Zip Code:45304-1425
Practice Address - Country:US
Practice Address - Phone:937-692-5007
Practice Address - Fax:937-548-3552
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35049160207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0528192Medicaid
OH0528192Medicaid
A84593Medicare UPIN