Healthcare Provider Details

I. General information

NPI: 1609945245
Provider Name (Legal Business Name): EILEEN P. RYAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 UPHAM DR
COLUMBUS OH
43210-1250
US

IV. Provider business mailing address

1670 UPHAM DR
COLUMBUS OH
43210-1250
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-9600
  • Fax:
Mailing address:
  • Phone: 614-293-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number34.012562
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: