Provider Demographics
NPI:1386222750
Name:LOUGHRAN, RYAN KEVIN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:KEVIN
Last Name:LOUGHRAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 HANOVER ST STE 200
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-3544
Mailing Address - Country:US
Mailing Address - Phone:570-808-5674
Mailing Address - Fax:
Practice Address - Street 1:166 HANOVER ST STE 200
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-3544
Practice Address - Country:US
Practice Address - Phone:570-808-5674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program