Provider Demographics
NPI:1366692311
Name:ANDREA L. RYAN D.O., P.C.
Entity Type:Organization
Organization Name:ANDREA L. RYAN D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:L
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:303-520-3263
Mailing Address - Street 1:7162 PINE HILLS WAY
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80125-7902
Mailing Address - Country:US
Mailing Address - Phone:303-520-3263
Mailing Address - Fax:
Practice Address - Street 1:2525 S DOWNING ST
Practice Address - Street 2:3 SOUTH
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5817
Practice Address - Country:US
Practice Address - Phone:303-520-3263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-26
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42273207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO22920358Medicaid
CO22920358Medicaid