Provider Demographics
NPI:1043396229
Name:RYAN, PHILIP J A (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:J A
Last Name:RYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:176 HEALTH CARE LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-4010
Mailing Address - Country:US
Mailing Address - Phone:304-260-1060
Mailing Address - Fax:304-260-1062
Practice Address - Street 1:176 HEALTH CARE LN
Practice Address - Street 2:SUITE B
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-4010
Practice Address - Country:US
Practice Address - Phone:304-260-1060
Practice Address - Fax:304-260-1062
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV01126207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2006615000Medicaid
WV0001714408OtherBLUE CROSS BLUE SHIELD
WVWV0833A548Medicare PIN
WV0001714408OtherBLUE CROSS BLUE SHIELD
WV4122311Medicare PIN