Healthcare Provider Details

I. General information

NPI: 1104822444
Provider Name (Legal Business Name): MARK HEHMAN RYAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 07/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E MARSHALL ST DEPT. OF FAMILY MEDICINE & POPULATION HEALTH
RICHMOND VA
23298-5051
US

IV. Provider business mailing address

PO BOX 91734
RICHMOND VA
23291-1734
US

V. Phone/Fax

Practice location:
  • Phone: 804-230-7777
  • Fax: 804-230-2071
Mailing address:
  • Phone: 804-358-6100
  • Fax: 804-342-7619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101231612
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: