Provider Demographics
NPI:1255321022
Name:RYAN, EDWARD THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:THOMAS
Last Name:RYAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-6454
Mailing Address - Fax:617-726-7653
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:GRJ 5 INFECTIOUS DISEASE ASSOCIATES
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-726-6175
Practice Address - Fax:617-726-7416
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA72191207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3168735Medicaid
MA072191OtherTUFTS HEALTH PLAN
MAJ09931OtherBCBS MA
MAJ09931Medicare ID - Type Unspecified
MA3168735Medicaid