MEDICARE: DR. RYAN KELLY MACVICAR MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171000000X	Military Health Care Provider

General Provider Information

NPI Number	:	1053242297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN KELLY MACVICAR MD

Provider Business Mailing Address
First Line	:	4494 PALMER RD N
Second Line	:	BLDG 19
City	:	BETHESDA
State	:	MD
Zip	:	20814
Country	:	US
Telephone Number	:	301-295-1795
Fax Number	:

Provider Business Practice Location Address
First Line	:	4494 PALMER RD N
Second Line	:	BLDG 19
City	:	BETHESDA
State	:	MD
Zip	:	20814
Country	:	US
Telephone Number	:	301-295-1795
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2026
Last Update Date	:	05/27/2026

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