Healthcare Provider Details

I. General information

NPI: 1326277740
Provider Name (Legal Business Name): JESSICA LYNN RYAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2009
Last Update Date: 10/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 QUEEN CITY AVE ELLIOT BREAST HEALTH CENTER
MANCHESTER NH
03101-7121
US

IV. Provider business mailing address

185 QUEEN CITY AVE ELLIOT BREAST HEALTH CENTER
MANCHESTER NH
03101-7121
US

V. Phone/Fax

Practice location:
  • Phone: 603-668-3067
  • Fax:
Mailing address:
  • Phone: 603-668-3067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number240861
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number17321
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: