Healthcare Provider Details

I. General information

NPI: 1497812184
Provider Name (Legal Business Name): MEG ELIZABETH RYAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 01/18/2020
Certification Date: 01/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8316 ARLINGTON BLVD STE 610
FAIRFAX VA
22031-5204
US

IV. Provider business mailing address

15805 SEURAT DR
NORTH POTOMAC MD
20878-3441
US

V. Phone/Fax

Practice location:
  • Phone: 703-698-2066
  • Fax: 703-698-7928
Mailing address:
  • Phone: 301-947-3931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number0101253057
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: