Healthcare Provider Details

I. General information

NPI: 1881993673
Provider Name (Legal Business Name): RYAN M MCKENZIE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2011
Last Update Date: 05/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 HEALTH CAMPUS DR
HARRISONBURG VA
22801
US

IV. Provider business mailing address

PO BOX 1430
HARRISONBURG VA
22803-1430
US

V. Phone/Fax

Practice location:
  • Phone: 540-689-1110
  • Fax: 540-689-1119
Mailing address:
  • Phone: 540-564-7084
  • Fax: 540-564-6847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101256221
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101256221
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: