Healthcare Provider Details

I. General information

NPI: 1568105351
Provider Name (Legal Business Name): DEREK MICHAEL RYAN NYE MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 12/24/2025
Certification Date: 12/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BROOKLINE AVENUE
BOSTON MA
02215
US

IV. Provider business mailing address

139 CRAWFORD ST UNIT 2
BOSTON MA
02121-1016
US

V. Phone/Fax

Practice location:
  • Phone: 617-667-7000
  • Fax:
Mailing address:
  • Phone: 646-535-3276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number1023304
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: