MEDICARE: DR. BENJAMIN C RYAN MD

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	220592	MA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
8	469892	OTHER	MA	TUFTS MEDICARE PREFERRED

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	43283986	OTHER		UNITED
2	AA17474	OTHER	MA	HPHC
3	469892	OTHER	MA	TUFTS HEALTH CARE
4	8688067	OTHER	MA	CIGNA
5	7272621	OTHER	MA	AETNA
6	91246	OTHER	MA	FALLON
7	1154312379	OTHER	MA	NEIGHBORHOOD HEALTH PLAN
9	042297845	OTHER	MA	TRICARE
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	J28136	OTHER	MA	BCBS
12	042297845	OTHER	MA	UNITED HEALTH CARE

NPI Number	:	1154312379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENJAMIN C RYAN MD

Provider Business Mailing Address
First Line	:	143 LONGWATER DR
Second Line	:
City	:	NORWELL
State	:	MA
Zip	:	02061-1683
Country	:	US
Telephone Number	:	781-878-5200
Fax Number	:	781-792-2971

Provider Business Practice Location Address
First Line	:	143 LONGWATER DR
Second Line	:
City	:	NORWELL
State	:	MA
Zip	:	02061-1683
Country	:	US
Telephone Number	:	781-878-5200
Fax Number	:	781-792-2971

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

Provider Enumeration Date	:	11/04/2005
Last Update Date	:	12/21/2015

143 LONGWATER DR , SOUTH SHORE MEDCAL CENTER, INC
NORWELL, MA
02061-1683

Practice Phone: 781-878-5200
Practice Fax: