Healthcare Provider Details

I. General information

NPI: 1518956754
Provider Name (Legal Business Name): THOMAS J RYAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 04/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2961A HUNTER MILL RD # 140
OAKTON VA
22124-1704
US

IV. Provider business mailing address

10330 HICKORY FOREST DR
OAKTON VA
22124-1523
US

V. Phone/Fax

Practice location:
  • Phone: 703-901-1383
  • Fax: 703-255-1091
Mailing address:
  • Phone: 703-255-3712
  • Fax: 703-255-1091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101032143
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: