Provider Demographics
NPI:1366428120
Name:BRYAN, RICHARD G (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:G
Last Name:BRYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:120 DUDLEY ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-2436
Mailing Address - Country:US
Mailing Address - Phone:401-369-7773
Mailing Address - Fax:401-369-7336
Practice Address - Street 1:120 DUDLEY ST
Practice Address - Street 2:SUITE 303
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-2436
Practice Address - Country:US
Practice Address - Phone:401-369-7773
Practice Address - Fax:401-369-7336
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIMD11942207WX0107X, 207W00000X
MA225844207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI603940OtherTUFTS GROUP #
RI6411654OtherCIGNA
MA2126478Medicaid
RI31547OtherNEIGHBORHOOD RI
RI9001520Medicaid
RI050493136OtherUNITED
RI1147102OtherAETNA
MA0037063OtherNEIGHBORHOOD MA
RI412894OtherBLUE CHIP
RI495317OtherTUFTS
MA9004425Medicaid
RI26587OtherRI BLUE SHIELD
RIAA43800OtherHARVARD
RIJ40022OtherMASS BLUE SHIELD
RI7058056Medicaid
RIP00266943OtherRAILROAD MEDICARE
RI6411654OtherCIGNA
RI495317OtherTUFTS