MEDICARE: GREGORY J RYAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	171753	NY

General Provider Information

NPI Number	:	1043249378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY J RYAN M.D.

Provider Business Mailing Address
First Line	:	601 ELMWOOD AVE
Second Line	:	BOX 278980
City	:	ROCHESTER
State	:	NY
Zip	:	14642-0001
Country	:	US
Telephone Number	:	585-787-0720
Fax Number	:	585-787-9108

Provider Business Practice Location Address
First Line	:	1900 EMPIRE BLVD
Second Line	:	SUITE 100
City	:	WEBSTER
State	:	NY
Zip	:	14580-1934
Country	:	US
Telephone Number	:	585-787-0720
Fax Number	:	585-787-9108

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	07/03/2023

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