Provider Demographics
NPI:1366457236
Name:RYSKIN, ALEXEY A (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXEY
Middle Name:A
Last Name:RYSKIN
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:P.O. BOX 1408
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-1408
Mailing Address - Country:US
Mailing Address - Phone:509-946-3340
Mailing Address - Fax:509-943-7909
Practice Address - Street 1:1075 JADWIN AVE
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3437
Practice Address - Country:US
Practice Address - Phone:509-946-3340
Practice Address - Fax:509-943-7909
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5566449-1205207LP2900X
WAMD60323495208VP0014X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA000067772OtherMEDICARE PTAN
UTI15417Medicare UPIN
WA000067772OtherMEDICARE PTAN