MEDICARE: DR. PATRICIA DOLAN 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	208M00000X	Hospitalist Physician	NY143724	NY

General Provider Information

NPI Number	:	1609204551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICIA DOLAN RYAN MD

Provider Business Mailing Address
First Line	:	130 SHORE RD
Second Line	:	166
City	:	PORT WASHINGTON
State	:	NY
Zip	:	11050-2205
Country	:	US
Telephone Number	:	516-365-7133
Fax Number	:	516-365-7133

Provider Business Practice Location Address
First Line	:	130 SHORE RD
Second Line	:	166
City	:	PORT WASHINGTON
State	:	NY
Zip	:	11050-2205
Country	:	US
Telephone Number	:	516-365-7133
Fax Number	:	516-365-7133

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

Provider Enumeration Date	:	10/30/2013
Last Update Date	:	10/30/2013

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