Provider Demographics
NPI:1427004605
Name:RYAN, KATHLEEN F (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:F
Last Name:RYAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1601 CHERRY ST
Mailing Address - Street 2:SUITE 11511
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-1321
Mailing Address - Country:US
Mailing Address - Phone:215-255-7822
Mailing Address - Fax:215-255-7825
Practice Address - Street 1:219 N BROAD ST
Practice Address - Street 2:6TH FL
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-1519
Practice Address - Country:US
Practice Address - Phone:215-762-5188
Practice Address - Fax:215-399-5896
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2012-10-04
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Provider Licenses
StateLicense IDTaxonomies
PAMD050740L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001482030Medicaid
PAF88430Medicare UPIN
PA001482030Medicaid