Provider Demographics
NPI:1447578299
Name:SEXTON, RYAN J (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:J
Last Name:SEXTON
Suffix:
Gender:M
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:PO BOX 905
Mailing Address - Street 2:1315 HOSPITAL DRIVE
Mailing Address - City:ST JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819-0905
Mailing Address - Country:US
Mailing Address - Phone:802-748-8141
Mailing Address - Fax:802-748-7541
Practice Address - Street 1:1315 HOSPITAL DR
Practice Address - Street 2:NORTHEASTERN VT REGIONAL HOSPITAL
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-9210
Practice Address - Country:US
Practice Address - Phone:802-748-8141
Practice Address - Fax:802-748-7541
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-04
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VT042-0013239207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1025571Medicaid
NH3101749Medicaid
NH3101749Medicaid