Provider Demographics
NPI:1437619384
Name:RYAN, JULIA (MD, PHD)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:
Other - Last Name:SVEDOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:UNIONVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06085-1131
Mailing Address - Country:US
Mailing Address - Phone:860-673-6124
Mailing Address - Fax:860-679-4624
Practice Address - Street 1:101 MAIN ST
Practice Address - Street 2:
Practice Address - City:UNIONVILLE
Practice Address - State:CT
Practice Address - Zip Code:06085-1131
Practice Address - Country:US
Practice Address - Phone:860-673-6124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT72691208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics