MEDICARE: MR. MICHAEL D. RYAN MSW

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	1041C0700X	Clinical Social Worker	LC3000800	DC

General Provider Information

NPI Number	:	1790883940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL D. RYAN MSW

Provider Business Mailing Address
First Line	:	5169 LINETTE LN
Second Line	:
City	:	ANNANDALE
State	:	VA
Zip	:	22003-4122
Country	:	US
Telephone Number	:	703-764-0767
Fax Number	:

Provider Business Practice Location Address
First Line	:	5169 LINETTE LN
Second Line	:
City	:	ANNANDALE
State	:	VA
Zip	:	22003-4122
Country	:	US
Telephone Number	:	703-764-0767
Fax Number	:

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	03/22/2026

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