Healthcare Provider Details

I. General information

NPI: 1073018958
Provider Name (Legal Business Name): RYAN J KASKY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2018
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E WILLIAMS AVE
FALLON NV
89406-3052
US

IV. Provider business mailing address

10510 JEFFERSON AVE STE A
NEWPORT NEWS VA
23601-3102
US

V. Phone/Fax

Practice location:
  • Phone: 775-867-7740
  • Fax: 775-867-7741
Mailing address:
  • Phone: 757-594-3800
  • Fax: 757-594-3818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO2996
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: