Healthcare Provider Details

I. General information

NPI: 1821611856
Provider Name (Legal Business Name): JAMES WILLIAM RYAN MB, BCH, BAO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2020
Last Update Date: 05/26/2020
Certification Date: 05/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST
BOSTON MA
02115-6110
US

IV. Provider business mailing address

48 MURTAGH ROAD STONEYBATTER
DUBLIN LEINSTER
DUBLIN7
IE

V. Phone/Fax

Practice location:
  • Phone: 617-732-6304
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number283089
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: