Provider Demographics
NPI:1073530432
Name:RYAN, PERRIE L (MD)
Entity Type:Individual
Prefix:
First Name:PERRIE
Middle Name:L
Last Name:RYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6069
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29171-6069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:222 E MEDICAL LN STE 400
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4848
Practice Address - Country:US
Practice Address - Phone:803-794-7511
Practice Address - Fax:803-794-7751
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA229854207R00000X
TN44872207RH0003X
VA0101245298207RH0003X
SC39335207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVVA751BMedicare PIN
TN103I112868Medicare PIN
TN103I111865Medicare PIN