Healthcare Provider Details

I. General information

NPI: 1811052855
Provider Name (Legal Business Name): RYAN ROBERT FORTNA M.D., PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3614 MERIDIAN ST SUITE 100
BELLINGHAM WA
98225-1748
US

IV. Provider business mailing address

3560 MERIDIAN ST STE 101
BELLINGHAM WA
98225-1731
US

V. Phone/Fax

Practice location:
  • Phone: 360-734-2800
  • Fax: 360-734-3818
Mailing address:
  • Phone: 360-734-2800
  • Fax: 360-734-3818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberMD60131035
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberMD60131035
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: