Provider Demographics
NPI:1245242981
Name:EVANS, RYAN V (MD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:V
Last Name:EVANS
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 1:20 HAGEN DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-2666
Mailing Address - Country:US
Mailing Address - Phone:585-586-7550
Mailing Address - Fax:585-586-7588
Practice Address - Street 1:20 HAGEN DR
Practice Address - Street 2:SUITE 300
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-2666
Practice Address - Country:US
Practice Address - Phone:585-586-7550
Practice Address - Fax:585-586-7588
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY2440552084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program