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General NPI Number Information
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NPI Number | 1548632581
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Entity Type | Individual
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Provider Name | RYAN DAVIS PA
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Gender | Male
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Dates
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Enumeration Date | 10/29/2015
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 50 WASON AVE FL 2
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City | SPRINGFIELD
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State | MA
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Zip | 01107-1280
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Country | US
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Telephone | 413-794-1800
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Fax |
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Provider Business Mailing Address
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Address Line | 225 BRIDGE ST
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City | GROTON
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State | CT
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Zip | 06340-3710
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Country | US
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Telephone | 860-917-8031
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA101950
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 3466
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License Number State | CT
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