MEDICARE: DR. MARK HEHMAN 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	207Q00000X	Family Medicine Physician	0101231612	VA

General Provider Information

NPI Number	:	1104822444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK HEHMAN RYAN MD

Provider Business Mailing Address
First Line	:	PO BOX 91734
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23291-1734
Country	:	US
Telephone Number	:	804-358-6100
Fax Number	:	804-342-7619

Provider Business Practice Location Address
First Line	:	1250 E MARSHALL ST
Second Line	:	DEPT. OF FAMILY MEDICINE & POPULATION HEALTH
City	:	RICHMOND
State	:	VA
Zip	:	23298-5051
Country	:	US
Telephone Number	:	804-230-7777
Fax Number	:	804-230-2071

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	07/02/2015

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