MEDICARE: DR. RYAN GIBSON AHALT D.P.M.

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	213ES0103X	Foot & Ankle Surgery Podiatrist	0103300963	VA

General Provider Information

NPI Number	:	1932126737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN GIBSON AHALT D.P.M.

Provider Business Mailing Address
First Line	:	8008 WESTPARK DR
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22102-3109
Country	:	US
Telephone Number	:	215-868-0659
Fax Number	:

Provider Business Practice Location Address
First Line	:	9008 WESTPARK DR
Second Line	:	KAISER PERMANENTE TYSONS CORNER MEDICAL CENTER
City	:	MCLEAN
State	:	VA
Zip	:	22102-3109
Country	:	US
Telephone Number	:	703-287-6400
Fax Number	:

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

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	07/23/2021

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