Provider Demographics
NPI:1093755373
Name:CARVALHO, RYAN S D (MD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:S D
Last Name:CARVALHO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RYAN
Other - Middle Name:PETER
Other - Last Name:CARVALHO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:555 S 18TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-2654
Mailing Address - Country:US
Mailing Address - Phone:614-722-3457
Mailing Address - Fax:614-722-3454
Practice Address - Street 1:555 S 18TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-2654
Practice Address - Country:US
Practice Address - Phone:614-722-3457
Practice Address - Fax:614-722-3454
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350877502080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCA4185302OtherOHIO MEDICARE
OH2667430Medicaid
OH2667430Medicaid