Provider Demographics
NPI:1083613186
Name:RYAN, EDWARD A (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:A
Last Name:RYAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:340 MAIN ST
Mailing Address - Street 2:STE. 670
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1604
Mailing Address - Country:US
Mailing Address - Phone:508-754-3566
Mailing Address - Fax:508-438-6368
Practice Address - Street 1:955 MAIN ST
Practice Address - Street 2:STE 108
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-1961
Practice Address - Country:US
Practice Address - Phone:787-721-0447
Practice Address - Fax:781-721-2250
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2011-10-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA71171207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2019191Medicaid
MAM08676Medicare PIN
B98632Medicare UPIN
MA2019191Medicaid