Healthcare Provider Details

I. General information

NPI: 1841386463
Provider Name (Legal Business Name): MICHAEL M RYAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 MARKET STREET
LEWISBERRY PA
17339
US

IV. Provider business mailing address

116 SOUTH GEORGE STREET SUITE 301
YORK PA
17401
US

V. Phone/Fax

Practice location:
  • Phone: 717-938-6695
  • Fax: 717-932-2589
Mailing address:
  • Phone: 717-845-8617
  • Fax: 717-854-6645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS008248L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: