Healthcare Provider Details

I. General information

NPI: 1720906233
Provider Name (Legal Business Name): RYAN FIELDMAN PRSS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25208 GEORGE WASHINGTON HWY
AURORA WV
26705-8036
US

IV. Provider business mailing address

124 FOUNTAIN VW
MORGANTOWN WV
26505-3849
US

V. Phone/Fax

Practice location:
  • Phone: 304-239-1214
  • Fax: 304-735-3620
Mailing address:
  • Phone: 304-239-1214
  • Fax: 304-735-3620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number18-900
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: