1205961042 NPI number — DR. LAWRENCE P RYAN DDS,MD

Table of content: DR. LAWRENCE P RYAN DDS,MD (NPI 1205961042)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205961042 NPI number — DR. LAWRENCE P RYAN DDS,MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RYAN
Provider First Name:
LAWRENCE
Provider Middle Name:
P
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS,MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205961042
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:
11 S MAIN ST
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
MARLBOROUGH
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06447-1553
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-295-8780
Provider Business Mailing Address Fax Number:
860-295-0875

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11 S MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
MARLBOROUGH
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06447-1553
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-295-8780
Provider Business Practice Location Address Fax Number:
860-295-0875
Provider Enumeration Date:
02/22/2007

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: 1223S0112X , with the licence number:  007529 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 020007529CT07 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 4332423 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 007529 . This is a "CONNECTICARE INSURANCE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 207529 . This is a "DELTA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0418117 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 204861 . This is a "CIGNA DENTAL HEALTH" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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