1326040783 NPI number — COLLEEN E RYAN MD

Table of content: COLLEEN E RYAN MD (NPI 1326040783)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326040783 NPI number — COLLEEN E RYAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RYAN
Provider First Name:
COLLEEN
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CORRODI
Provider Other First Name:
COLLEEN
Provider Other Middle Name:
R
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1326040783
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1350 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALPOLE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02081-1718
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-668-2200
Provider Business Mailing Address Fax Number:
508-668-6539

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1350 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALPOLE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02081-1718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-668-2200
Provider Business Practice Location Address Fax Number:
508-668-6539
Provider Enumeration Date:
08/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  79455 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3125998 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 36145 . This is a "CMSP/HSP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9314935 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4514287 . This is a "AETNA/US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 920717 . This is a "AETNA/US HEALTHCARE HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 79455 . This is a "MEDICAL LIC" identifier . This identifiers is of the category "OTHER".
  • Identifier: J14629 . This is a "BCBS-MA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 079455 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200481 . This is a "HPHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3125998 . This is a "MEDICAID-MA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P2967576 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".




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