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General NPI Number Information
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NPI Number | 1891970893
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Entity Type | Organization
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Legal Business Name | GORDON A.RYAN,MD PC
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Dates
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Enumeration Date | 01/08/2008
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Last Update Date | 01/08/2008
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Provider Practice Location Address
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Address Line | 400 GRESHAM DR SUITE 411
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City | NORFOLK
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State | VA
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Zip | 23507-1901
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Country | US
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Telephone | 757-624-9433
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Fax | 757-624-6884
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Provider Business Mailing Address
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Address Line | 400 GRESHAM DR SUITE 411
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City | NORFOLK
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State | VA
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Zip | 23507-1901
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Country | US
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Telephone | 757-624-9433
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Fax | 757-624-6884
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Authorized Official
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Title or Position | OFFICE MGR.
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Name | MRS. MILDRED R COLE
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Credential | RMA
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Telephone | 757-624-9433
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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 | 0101034688
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License Number State | VA
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