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General NPI Number Information
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NPI Number | 1659356905
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Entity Type | Individual
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Provider Name | KATHLEEN L RYAN M.D.
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Gender | Female
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Dates
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Enumeration Date | 12/09/2005
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 3412 PENNINGTON DR
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City | WALPOLE
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State | MA
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Zip | 02081-1078
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Country | US
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Telephone | 609-744-8046
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Fax | 815-331-0775
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Provider Business Mailing Address
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Address Line | 3412 PENNINGTON DR
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City | WALPOLE
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State | MA
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Zip | 02081-1078
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Country | US
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Telephone | 609-744-8046
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Fax | 815-331-0775
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 25MA04982500
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 25MA04982500
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number | 25MA04982500
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License Number State | NJ
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Taxonomy #4
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 50223
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License Number State | MA
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