Provider Demographics
NPI:1366461378
Name:RYAN, COLLEEN M (MD)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:M
Last Name:RYAN
Suffix:
Gender:F
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:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:55 FRUIT STREET
Practice Address - Street 2:GRB 1302 TRAUMA AND SURGICAL CRITICAL CARE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-726-3184
Practice Address - Fax:617-724-8432
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA58911208600000X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery
Not Answered2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3040771Medicaid
MA728616OtherTUFTS HEALTH PLAN
MAJ07975OtherBCBS MA
MAJ07975Medicare ID - Type Unspecified
MAJ07975OtherBCBS MA