Healthcare Provider Details

I. General information

NPI: 1770109761
Provider Name (Legal Business Name): JOHN RYAN GEDNEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2020
Last Update Date: 06/25/2020
Certification Date: 06/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 ASHLEY AVENUE ROOM 202 MAIN HOSPITAL, MSC333
CHARLESTON SC
29425
US

IV. Provider business mailing address

169 ASHLEY AVENUE ROOM 202 MAIN HOSPITAL, MSC333
CHARLESTON SC
29425
US

V. Phone/Fax

Practice location:
  • Phone: 720-838-5843
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberLL84642
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: