Healthcare Provider Details

I. General information

NPI: 1184689689
Provider Name (Legal Business Name): JEAN C. RYAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 GREENLAND RD BUILDING A-1
PORTSMOUTH NH
03801-4164
US

IV. Provider business mailing address

875 GREENLAND RD BUILDING A-1
PORTSMOUTH NH
03801-4164
US

V. Phone/Fax

Practice location:
  • Phone: 603-436-1128
  • Fax: 603-431-4537
Mailing address:
  • Phone: 603-436-1128
  • Fax: 603-431-4537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number10061
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: