Healthcare Provider Details

I. General information

NPI: 1457675589
Provider Name (Legal Business Name): RYAN D WALKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2010
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 ROUTE 70 E STE 1
CHERRY HILL NJ
08003-2141
US

IV. Provider business mailing address

1940 ROUTE 70 E STE 1
CHERRY HILL NJ
08003-2141
US

V. Phone/Fax

Practice location:
  • Phone: 609-696-5929
  • Fax: 609-696-5619
Mailing address:
  • Phone: 609-696-5929
  • Fax: 609-696-5619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number25MA09871200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number25MA09871200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: