Provider Demographics
NPI:1235142480
Name:SCANNELL, RYAN B (MD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:B
Last Name:SCANNELL
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 1:85 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03246-3113
Mailing Address - Country:US
Mailing Address - Phone:603-524-7402
Mailing Address - Fax:603-524-0945
Practice Address - Street 1:189A HIGH ST
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-3864
Practice Address - Country:US
Practice Address - Phone:603-630-7333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH13643174400000X, 207Y00000X, 207YX0602X, 207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
7976870OtherAETNA
I67437OtherACS/HEALTHNET OF NE
NH30207005Medicaid
01Y012271NH01OtherBCBS
0742513OtherCIGNA
9607945OtherGHI
AA95773OtherHARVARD PILGRIM
000164101Medicare UPIN