Healthcare Provider Details

I. General information

NPI: 1427639954
Provider Name (Legal Business Name): RYAN ROBERT WILSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2021
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 BURTNER RD
NATRONA HEIGHTS PA
15065-2845
US

IV. Provider business mailing address

1604 BURTNER RD
NATRONA HEIGHTS PA
15065-2845
US

V. Phone/Fax

Practice location:
  • Phone: 724-226-1400
  • Fax: 724-226-1460
Mailing address:
  • Phone: 724-226-1400
  • Fax: 724-226-1460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS024732
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: