Healthcare Provider Details

I. General information

NPI: 1174671838
Provider Name (Legal Business Name): PORTSMOUTH PULMONARY PHYSICIANS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BORTHWICK AVE JACKSON-GRAY BUILDING, SUITE106
PORTSMOUTH NH
03801-4174
US

IV. Provider business mailing address

330 BORTHWICK AVE JACKSON-GRAY BUILDING, SUITE106
PORTSMOUTH NH
03801-4174
US

V. Phone/Fax

Practice location:
  • Phone: 603-436-4614
  • Fax:
Mailing address:
  • Phone: 603-436-4614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number13383
License Number StateNH

VIII. Authorized Official

Name: DR. DAVID LS RYON
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 603-436-4614