Healthcare Provider Details

I. General information

NPI: 1710330113
Provider Name (Legal Business Name): LUNDEN LISTON RYAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2016
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 WASHINGTON BLVD
BELPRE OH
45714-2465
US

IV. Provider business mailing address

PO BOX 9196
MORGANTOWN WV
26506-9196
US

V. Phone/Fax

Practice location:
  • Phone: 304-485-8040
  • Fax: 304-485-4883
Mailing address:
  • Phone: 304-293-1168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number35.146094
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number28383
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateWV
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberTP213
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: