Healthcare Provider Details

I. General information

NPI: 1346243086
Provider Name (Legal Business Name): CHARLES R RYAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2005
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 W HIGH ST STE 101
LIMA OH
45801-3968
US

IV. Provider business mailing address

830 W HIGH ST STE 101
LIMA OH
45801-3968
US

V. Phone/Fax

Practice location:
  • Phone: 419-227-0610
  • Fax: 419-228-3273
Mailing address:
  • Phone: 419-227-0610
  • Fax: 419-228-3273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35-03-7667-R
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: