Healthcare Provider Details

I. General information

NPI: 1972586014
Provider Name (Legal Business Name): GAYLE BLANCHARD RYAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1349 CUMBERLAND ST
LEBANON PA
17042-4529
US

IV. Provider business mailing address

1349 CUMBERLAND ST
LEBANON PA
17042-4529
US

V. Phone/Fax

Practice location:
  • Phone: 717-256-3075
  • Fax:
Mailing address:
  • Phone: 717-256-3075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberMD445743
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD445743
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: