Basic Information
| Provider Information | |||||||||
| NPI: | 1700828878 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RIEBEL | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | DAVID | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8310 | ||||||||
| Address2: | |||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240140310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403453556 | ||||||||
| FaxNumber: | 5407771147 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 KNOTBREAK RD | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | VA | ||||||||
| PostalCode: | 241535404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5404444020 | ||||||||
| FaxNumber: | 5404444021 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2006 | ||||||||
| LastUpdateDate: | 01/25/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0117X | 0101057389 | VA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine |
ID Information
| ID | Type | State | Issuer | Description | 700201860 | 01 | VA | CIGNA | OTHER | 4503802 | 01 | VA | AETNA | OTHER | 200040421 | 01 | VA | RAILROAD MEDICARE | OTHER | 542006922 | 01 | VA | UNITED HEALTHCARE | OTHER | 3933260001 | 01 | VA | ADMINISTAR FEDERAL | OTHER | 452547 | 01 | VA | ANTHEM | OTHER | 127777 | 01 | VA | SOUTHERN HEALTH | OTHER | 286128 | 01 | VA | MAMSI | OTHER | 006401121 | 05 | VA | MEDICAID |