Provider Demographics
NPI:1154312379
Name:RYAN, BENJAMIN C (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:C
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 1:143 LONGWATER DR
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1683
Mailing Address - Country:US
Mailing Address - Phone:781-878-5200
Mailing Address - Fax:781-792-2971
Practice Address - Street 1:143 LONGWATER DR
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1683
Practice Address - Country:US
Practice Address - Phone:781-878-5200
Practice Address - Fax:781-792-2971
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA220592207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
43283986OtherUNITED
MAAA17474OtherHPHC
MA469892OtherTUFTS HEALTH CARE
MA8688067OtherCIGNA
MA7272621OtherAETNA
MA91246OtherFALLON
MA1154312379OtherNEIGHBORHOOD HEALTH PLAN
MA469892OtherTUFTS MEDICARE PREFERRED
MA042297845OtherTRICARE
MA2085861Medicaid
MAJ28136OtherBCBS
MA042297845OtherUNITED HEALTH CARE
MA8688067OtherCIGNA
MAA3772401Medicare PIN
MA1154312379OtherNEIGHBORHOOD HEALTH PLAN