Provider Demographics
NPI:1417481771
Name:RYAN, COLIN PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:COLIN
Middle Name:PATRICK
Last Name:RYAN
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 1:701 TECH CENTER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-1987
Mailing Address - Country:US
Mailing Address - Phone:440-724-4498
Mailing Address - Fax:
Practice Address - Street 1:350 W WILSON BRIDGE RD STE 100
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-2590
Practice Address - Country:US
Practice Address - Phone:614-944-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-13
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.145900208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology