Provider Demographics
NPI:1467546457
Name:VIENNA, RYAN PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:PATRICK
Last Name:VIENNA
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:NAVAL HEALTH CLINIC HAWAII
Mailing Address - Street 2:480 CENTRAL AVENUE
Mailing Address - City:PEARL HARBOR
Mailing Address - State:HI
Mailing Address - Zip Code:96860
Mailing Address - Country:US
Mailing Address - Phone:808-474-4242
Mailing Address - Fax:
Practice Address - Street 1:NAVAL HEALTH CLINIC HAWAII
Practice Address - Street 2:480 CENTRAL AVENUE
Practice Address - City:PEARL HARBOR
Practice Address - State:HI
Practice Address - Zip Code:96860
Practice Address - Country:US
Practice Address - Phone:808-474-4242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
247200000X
NE289452084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE28945OtherMEDICAL LICENSE