Healthcare Provider Details

I. General information

NPI: 1174516553
Provider Name (Legal Business Name): RYAN D NEWELL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 01/09/2025
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5493 MAPLE LN
FAYETTEVILLE WV
25840-6872
US

IV. Provider business mailing address

252 RURAL ACRES DR
BECKLEY WV
25801-3503
US

V. Phone/Fax

Practice location:
  • Phone: 304-469-3334
  • Fax: 304-465-1735
Mailing address:
  • Phone: 304-253-2638
  • Fax: 304-252-1720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1821
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: