MEDICARE: DR. AMY L 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	208000000X	Pediatrics Physician	57778	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730143264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY L RYAN MD

Provider Business Mailing Address
First Line	:	71 ORCHARD FARM RD
Second Line	:
City	:	YORK
State	:	ME
Zip	:	03909-1331
Country	:	US
Telephone Number	:	207-363-6959
Fax Number	:

Provider Business Practice Location Address
First Line	:	319 LONGWOOD AVE
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02115-5728
Country	:	US
Telephone Number	:	617-355-7318
Fax Number	:	617-277-7834

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

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	07/08/2007

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