Healthcare Provider Details

I. General information

NPI: 1184887937
Provider Name (Legal Business Name): RYAN K BRANNON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 05/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 N 15TH ST # MS 495 ROOM 16121, 16FH FL - NCB
PHILADELPHIA PA
19102-1101
US

IV. Provider business mailing address

1601 CHERRY ST SUITE 11511
PHILADELPHIA PA
19102-1320
US

V. Phone/Fax

Practice location:
  • Phone: 215-762-8220
  • Fax: 215-762-1470
Mailing address:
  • Phone: 215-255-7822
  • Fax: 215-255-7825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD442294
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: