MEDICARE: DR. RYAN REID KING M.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	207R00000X	Internal Medicine Physician	MT198879	PA
2	207R00000X	Internal Medicine Physician	64475	MN
3	207R00000X	Internal Medicine Physician	MD451345	PA

General Provider Information

NPI Number	:	1629364484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN REID KING M.D.

Provider Business Mailing Address
First Line	:	PO BOX 13579
Second Line	:
City	:	READING
State	:	PA
Zip	:	19612-3579
Country	:	US
Telephone Number	:	484-628-1324
Fax Number	:

Provider Business Practice Location Address
First Line	:	1502 N PHILIP ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19122-3867
Country	:	US
Telephone Number	:	215-284-2520
Fax Number	:

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

Provider Enumeration Date	:	06/21/2011
Last Update Date	:	11/02/2023

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