Healthcare Provider Details

I. General information

NPI: 1487330445
Provider Name (Legal Business Name): RYAN KIDD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 UNIVERSITY DRIVE
HERSHEY PA
17033
US

IV. Provider business mailing address

3134 GROVE CT
MECHANICSBURG PA
17055-8725
US

V. Phone/Fax

Practice location:
  • Phone: 800-243-1455
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberOT025609
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number15170
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: