Provider Demographics
NPI:1215984190
Name:BRIAN O'MALLEY & WILSA J. RYDER, PTR
Entity type:Organization
Organization Name:BRIAN O'MALLEY & WILSA J. RYDER, PTR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:WILSA
Authorized Official - Middle Name:J
Authorized Official - Last Name:RYDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-487-3505
Mailing Address - Street 1:16 SHANK PAINTER RD
Mailing Address - Street 2:
Mailing Address - City:PROVINCETOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02657-1343
Mailing Address - Country:US
Mailing Address - Phone:508-487-3505
Mailing Address - Fax:508-487-9023
Practice Address - Street 1:16 SHANK PAINTER RD
Practice Address - Street 2:
Practice Address - City:PROVINCETOWN
Practice Address - State:MA
Practice Address - Zip Code:02657-1343
Practice Address - Country:US
Practice Address - Phone:508-487-3505
Practice Address - Fax:508-487-9023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty