Healthcare Provider Details

I. General information

NPI: 1720344849
Provider Name (Legal Business Name): RYAN URBAS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 06/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 W WASHINGTON SQ 4TH FL
PHILADELPHIA PA
19104
US

IV. Provider business mailing address

230 W WASHINGTON SQ 4TH FL
PHILADELPHIA PA
19104-3500
US

V. Phone/Fax

Practice location:
  • Phone: 215-829-3561
  • Fax: 215-829-3020
Mailing address:
  • Phone: 215-829-3561
  • Fax: 215-829-3020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS018470
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberOS018470
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberOS018470
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: