Provider Demographics
NPI:1437541570
Name:CARBAUGH, RYAN MATTHEW (DO)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:MATTHEW
Last Name:CARBAUGH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 W WALNUT ST
Mailing Address - Street 2:STE A
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-1832
Mailing Address - Country:US
Mailing Address - Phone:859-239-5870
Mailing Address - Fax:
Practice Address - Street 1:216 W WALNUT ST STE A
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-1832
Practice Address - Country:US
Practice Address - Phone:859-239-5870
Practice Address - Fax:859-239-5879
Is Sole Proprietor?:No
Enumeration Date:2015-02-26
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.012951207R00000X
KY04706207R00000X, 207RG0100X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program