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General NPI Number Information
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NPI Number | 1093033789
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Entity Type | Individual
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Provider Name | RYAN JOHN WAKIM M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/05/2010
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Last Update Date | 09/17/2025
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Provider Practice Location Address
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Address Line | 1100 MAIN ST STE 104
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City | WHEELING
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State | WV
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Zip | 26003-2737
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Country | US
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Telephone | 304-460-5123
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Fax | 888-276-3121
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Provider Business Mailing Address
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Address Line | 1005 WHITE WILLOW WAY ATTN: RACHEL DETEC
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City | MORGANTOWN
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State | WV
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Zip | 26505-6119
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Country | US
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Telephone | 304-280-7337
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | D0090198
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 52407
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | DR.0064121
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License Number State | CO
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 69641
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License Number State | CT
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Taxonomy #5
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME143130
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License Number State | FL
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Taxonomy #6
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD458987
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License Number State | PA
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Taxonomy #7
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 21739
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License Number State | NH
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Taxonomy #8
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 41470
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License Number State | AL
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Taxonomy #9
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036156879
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License Number State | IL
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Taxonomy #10
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 84710
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License Number State | GA
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Taxonomy #11
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 35.136307
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License Number State | OH
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Taxonomy #12
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 24727
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License Number State | WV
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Taxonomy #13
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 303652
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License Number State | NY
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Taxonomy #14
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #15
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 53466
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License Number State | KY
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