Provider Demographics
NPI:1386733780
Name:RYAN, MARILYN (MD)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:21 INDUSTRIAL BLVD
Mailing Address - Street 2:SUITE #21
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1610
Mailing Address - Country:US
Mailing Address - Phone:610-251-0300
Mailing Address - Fax:610-251-0304
Practice Address - Street 1:21 INDUSTRIAL BLVD
Practice Address - Street 2:SUITE #21
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1610
Practice Address - Country:US
Practice Address - Phone:610-251-0300
Practice Address - Fax:610-251-0304
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2010-03-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD025002E207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC28921Medicare UPIN