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NPI Code Detail

MEDICARE: JENNIFER RYAN D.O.

MEDICARE: JENNIFER RYAN D.O.
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
1207Q00000XFamily Medicine Physician214124MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1467427708
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER RYAN D.O.
Provider Business Mailing Address
First Line : 57 CITY HALL AVE
Second Line :
City : GARDNER
State : MA
Zip : 01440-2614
Country : US
Telephone Number : 978-630-3862
Fax Number : 978-630-4176
Provider Business Practice Location Address
First Line : 57 CITY HALL AVE
Second Line :
City : GARDNER
State : MA
Zip : 01440-2614
Country : US
Telephone Number : 978-630-3862
Fax Number : 978-630-4176
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2006
Last Update Date : 11/29/2007

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Directions to “ JENNIFER RYAN D.O.” Practice Location

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