MEDICARE: DR. RYAN S AZZAM DO

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	207R00000X	Internal Medicine Physician	0116031171	VA
2	208M00000X	Hospitalist Physician	334770	NY

General Provider Information

NPI Number	:	1225567258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN S AZZAM DO

Provider Business Mailing Address
First Line	:	425 NEW SCOTLAND AVE
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12208-2726
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	315 S MANNING BLVD
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12208-1707
Country	:	US
Telephone Number	:	518-525-8600
Fax Number	:	518-525-6545

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

Provider Enumeration Date	:	06/04/2017
Last Update Date	:	05/08/2025

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