Healthcare Provider Details

I. General information

NPI: 1104924570
Provider Name (Legal Business Name): WILLIAM D RYAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 11/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 MAIN ST.
WHITESBORO NY
13492
US

IV. Provider business mailing address

2209 GENESEE ST BUSINESS OFFICE
UTICA NY
13501-5930
US

V. Phone/Fax

Practice location:
  • Phone: 315-736-9337
  • Fax: 315-624-5152
Mailing address:
  • Phone: 315-801-3282
  • Fax: 315-801-8391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number150498
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: