Provider Demographics
NPI:1356448369
Name:RYAN, MELANIE SCURRY (MD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:SCURRY
Last Name:RYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5450 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2709
Mailing Address - Country:US
Mailing Address - Phone:303-415-4250
Mailing Address - Fax:303-440-9629
Practice Address - Street 1:5495 ARAPAHOE AVE STE 100
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1224
Practice Address - Country:US
Practice Address - Phone:303-415-4250
Practice Address - Fax:303-440-9629
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0042286207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO62237071Medicaid
GO9830Medicare UPIN
CO62237071Medicaid