MEDICARE: EDWARD A RYAN MD

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	207W00000X	Ophthalmology Physician	71171	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083613186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD A RYAN MD

Provider Business Mailing Address
First Line	:	340 MAIN ST
Second Line	:	STE. 670
City	:	WORCESTER
State	:	MA
Zip	:	01608-1604
Country	:	US
Telephone Number	:	508-754-3566
Fax Number	:	508-438-6368

Provider Business Practice Location Address
First Line	:	955 MAIN ST
Second Line	:	STE 108
City	:	WINCHESTER
State	:	MA
Zip	:	01890-1961
Country	:	US
Telephone Number	:	787-721-0447
Fax Number	:	781-721-2250

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

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	10/18/2011

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