MEDICARE: RYAN FITZNER 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	390200000X	Student in an Organized Health Care Education/Training Program
2	207P00000X	Emergency Medicine Physician	14266288-1204	UT

General Provider Information

NPI Number	:	1851041412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN FITZNER DO

Provider Business Mailing Address
First Line	:	100 N ACADEMY AVE # MC13-10
Second Line	:
City	:	DANVILLE
State	:	PA
Zip	:	17822-9800
Country	:	US
Telephone Number	:	570-271-6812
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 N ACADEMY AVE # MC13-10
Second Line	:
City	:	DANVILLE
State	:	PA
Zip	:	17822-9800
Country	:	US
Telephone Number	:	570-271-6812
Fax Number	:

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

Provider Enumeration Date	:	03/26/2022
Last Update Date	:	02/03/2026

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