MEDICARE: DR. RYAN INSHAN ALLY 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	0116024464	VA

General Provider Information

NPI Number	:	1093075715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN INSHAN ALLY M.D.

Provider Business Mailing Address
First Line	:	2500 POCOSHOCK PL
Second Line	:	SUITE 104
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-6345
Country	:	US
Telephone Number	:	804-276-9305
Fax Number	:	804-674-4145

Provider Business Practice Location Address
First Line	:	2500 POCOSHOCK PL
Second Line	:	SUITE 104
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-6345
Country	:	US
Telephone Number	:	804-276-9305
Fax Number	:	804-674-4145

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

Provider Enumeration Date	:	05/29/2012
Last Update Date	:	09/25/2014

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