Healthcare Provider Details

I. General information

NPI: 1871571760
Provider Name (Legal Business Name): RYAN ROBERT MAENPA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 MIAMISBURG CENTERVILLE RD
CENTERVILLE FINANCE OH
45459-3811
US

IV. Provider business mailing address

1975 MIAMISBURG CENTERVILLE RD
CENTERVILLE OH
45459-3811
US

V. Phone/Fax

Practice location:
  • Phone: 937-298-5536
  • Fax: 937-298-5596
Mailing address:
  • Phone: 937-439-6186
  • Fax: 937-439-9900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number35-08-8161-M
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: