Healthcare Provider Details

I. General information

NPI: 1124287370
Provider Name (Legal Business Name): RYAN RESTREPO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2008
Last Update Date: 06/10/2022
Certification Date: 06/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8930 BROWN DRIVE ARROWHEAD ZONE-BLDG 9, FL 2
BETHESDA MD
20889-5629
US

IV. Provider business mailing address

8930 BROWN DRIVE ARROWHEAD ZONE-BLDG 9, FL 2
BETHESDA MD
20889-5629
US

V. Phone/Fax

Practice location:
  • Phone: 301-319-4226
  • Fax: 301-295-0226
Mailing address:
  • Phone: 301-319-4226
  • Fax: 301-295-0226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101245999
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number0101245999
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: