Provider Demographics
NPI:1083608954
Name:RYAN, COURTNEY KATHERINE (MD)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:KATHERINE
Last Name:RYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5645 STONE RD
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-1618
Mailing Address - Country:US
Mailing Address - Phone:703-266-2442
Mailing Address - Fax:703-266-7158
Practice Address - Street 1:111 WEST HIGH STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921
Practice Address - Country:US
Practice Address - Phone:410-996-9490
Practice Address - Fax:410-996-9493
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0065437207Q00000X
DEC1-0007183207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine