Provider Demographics
NPI:1437189982
Name:RYDER, MARY TERESA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:TERESA
Last Name:RYDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5780 WESTCHESTER ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-1145
Mailing Address - Country:US
Mailing Address - Phone:703-719-0461
Mailing Address - Fax:
Practice Address - Street 1:9500 RICHMOND HWY
Practice Address - Street 2:
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-2124
Practice Address - Country:US
Practice Address - Phone:703-339-7788
Practice Address - Fax:703-339-5713
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101052496207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008520W000Medicare ID - Type Unspecified
VAG09387Medicare UPIN
DCG00500Medicare PIN