Healthcare Provider Details

I. General information

NPI: 1922569912
Provider Name (Legal Business Name): RYAN THACHER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2019
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 DANBURY RD STE 100
WILTON CT
06897-4405
US

IV. Provider business mailing address

18444 N 25TH AVE STE 310
PHOENIX AZ
85023-1266
US

V. Phone/Fax

Practice location:
  • Phone: 203-845-2200
  • Fax:
Mailing address:
  • Phone: 623-241-8682
  • Fax: 480-499-8459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number82761
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: