Healthcare Provider Details

I. General information

NPI: 1154288645
Provider Name (Legal Business Name): MEGAN EMILY RYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 E LOMBARD ST
BALTIMORE MD
21231-1921
US

IV. Provider business mailing address

2005 E LOMBARD ST
BALTIMORE MD
21231-1921
US

V. Phone/Fax

Practice location:
  • Phone: 813-389-3200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA2387
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: