Healthcare Provider Details

I. General information

NPI: 1932136926
Provider Name (Legal Business Name): RYAN MICHAEL JANDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 01/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8926 WOODYARD ROAD SUITE 701
CLINTON MD
20735
US

IV. Provider business mailing address

8926 WOODYARD ROAD SUITE 701
CLINTON MD
20735
US

V. Phone/Fax

Practice location:
  • Phone: 301-856-1682
  • Fax: 301-856-0964
Mailing address:
  • Phone: 301-856-1682
  • Fax: 301-856-0964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberD0064678
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0101239951
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD036127
License Number StateDC
# 4
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberD0064678
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number0101239951
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: