Healthcare Provider Details

I. General information

NPI: 1659022663
Provider Name (Legal Business Name): RYAN MAYNE DAVIES PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2022
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 CARLISLE ST
NATRONA HEIGHTS PA
15065-1152
US

IV. Provider business mailing address

1301 CARLISLE ST
NATRONA HEIGHTS PA
15065-1152
US

V. Phone/Fax

Practice location:
  • Phone: 412-330-4363
  • Fax:
Mailing address:
  • Phone: 412-330-4363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA007729
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: