MEDICARE: DR. PAMELA A RYAN PH.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	103T00000X	Psychologist	811	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9381616	OTHER	WV	PHCS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467445353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAMELA A RYAN PH.D.

Provider Business Mailing Address
First Line	:	134 E 2ND AVE
Second Line	:
City	:	WILLIAMSON
State	:	WV
Zip	:	25661-3602
Country	:	US
Telephone Number	:	304-235-1200
Fax Number	:	304-235-1945

Provider Business Practice Location Address
First Line	:	134 E 2ND AVE
Second Line	:
City	:	WILLIAMSON
State	:	WV
Zip	:	25661-3602
Country	:	US
Telephone Number	:	304-235-1200
Fax Number	:	304-235-1945

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

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	07/09/2007

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