Provider Demographics
NPI:1437173218
Name:GANTZ, RYAN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:
Last Name:GANTZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 WHEATLAND AVE
Mailing Address - Street 2:P O BOX 3216
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-3180
Mailing Address - Country:US
Mailing Address - Phone:717-394-6028
Mailing Address - Fax:717-394-9223
Practice Address - Street 1:555 N DUKE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2250
Practice Address - Country:US
Practice Address - Phone:717-299-4173
Practice Address - Fax:717-295-4773
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA003533L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102690Medicare PIN
PAP40646Medicare UPIN