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General NPI Number Information
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NPI Number | 1639529910
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Entity Type | Individual
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Provider Name | RYAN ANTHONY FISICARO M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/16/2016
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Last Update Date | 06/17/2024
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Provider Practice Location Address
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Address Line | 1301 PUNCHBOWL ST
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City | HONOLULU
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State | HI
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Zip | 96813-2499
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Country | US
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Telephone | 808-691-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 5501 OLD YORK RD ALBERT EINSTEIN MEDICAL CENTER
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City | PHILADELPHIA
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State | PA
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Zip | 19141-3018
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Country | US
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Telephone | 215-456-7890
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | MT211183
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD24354
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License Number State | HI
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