Healthcare Provider Details

I. General information

NPI: 1467430108
Provider Name (Legal Business Name): SEAN P RYAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 02/16/2021
Certification Date: 02/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4104 STATE HIGHWAY 30
AMSTERDAM NY
12010-6202
US

IV. Provider business mailing address

99 E STATE ST
GLOVERSVILLE NY
12078-1203
US

V. Phone/Fax

Practice location:
  • Phone: 518-883-8634
  • Fax: 518-843-8286
Mailing address:
  • Phone: 518-773-5758
  • Fax: 518-773-5653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number216322
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: