Provider Demographics
NPI:1114082971
Name:RYAN, STEPHEN M (PA-C)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:M
Last Name:RYAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2100 MACK BLVD FL 4
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-5622
Mailing Address - Country:US
Mailing Address - Phone:484-884-0469
Mailing Address - Fax:484-884-0628
Practice Address - Street 1:2401 NORTHAMPTON ST STE 140
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-2764
Practice Address - Country:US
Practice Address - Phone:484-591-7430
Practice Address - Fax:484-591-7431
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD051024363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P70206Medicare UPIN
PA522156MWAMedicare PIN
PA522156MWAMedicare PIN