Healthcare Provider Details

I. General information

NPI: 1538917737
Provider Name (Legal Business Name): RYAN BYRNE MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2024
Last Update Date: 05/11/2024
Certification Date: 05/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9263 MEDICAL PLAZA DR STE A
NORTH CHARLESTON SC
29406-7112
US

IV. Provider business mailing address

1042 JAMSIE COVE DR
CHARLESTON SC
29412-4965
US

V. Phone/Fax

Practice location:
  • Phone: 843-377-1600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084S0010X
TaxonomySports Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RYAN ROBERT BYRNE
Title or Position: ORGANIZER
Credential: MD
Phone: 414-426-6332