Provider Demographics
NPI:1366414104
Name:RIEDLER, JOHN FLORIAN (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FLORIAN
Last Name:RIEDLER
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 1:500 VIKING DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7477
Mailing Address - Country:US
Mailing Address - Phone:757-468-0550
Mailing Address - Fax:757-468-9992
Practice Address - Street 1:500 VIKING DR
Practice Address - Street 2:SUITE 200
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7477
Practice Address - Country:US
Practice Address - Phone:757-468-0550
Practice Address - Fax:757-468-9992
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE150532084A0401X
VA01010548942084P0800X
IA218762084P0804X
AZ137432084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
260051194OtherMCARE RAILROAD
292381OtherBCBS
VA007117817Medicaid
16338OtherVALUE OPTIONS
243512OtherMANAGED HEALTH NETWORK
C01884OtherMCARE GROUP
089431OtherSENTARA OPTIMA
121837OtherMAGELLAN
362206OtherMAMSI
292381OtherANTHEM PPO
2005218OtherCIGNA
292381OtherANTHEM HEALTH KEEPERS
VA260003122Medicare ID - Type Unspecified
VA007117817Medicaid