Provider Demographics
NPI:1316441066
Name:KARMOUTA, RYAN (MD, MBA)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:KARMOUTA
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 NEW HAMPSHIRE AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-2864
Mailing Address - Country:US
Mailing Address - Phone:802-909-2053
Mailing Address - Fax:
Practice Address - Street 1:31 STILES RD STE 2100
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-3035
Practice Address - Country:US
Practice Address - Phone:603-942-2020
Practice Address - Fax:603-288-1722
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY318928207N00000X
PAMD479452207N00000X
MEMD26935207N00000X
NH22327207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology