Provider Demographics
NPI:1477654473
Name:HARRIS, RYAN NATHANIEL (DO)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:NATHANIEL
Last Name:HARRIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2900 LAMB CIR
Mailing Address - Street 2:SUITE L 760
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-6344
Mailing Address - Country:US
Mailing Address - Phone:540-731-2436
Mailing Address - Fax:540-731-2439
Practice Address - Street 1:2900 LAMB CIR
Practice Address - Street 2:SUITE L 760
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-6344
Practice Address - Country:US
Practice Address - Phone:540-731-2436
Practice Address - Fax:540-731-2439
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOTO11281207X00000X
PAOSO138282083A0100X
VA0102203415207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1477654473OtherVA PREMIER
VA1477654473Medicaid
VAVVC734BOtherMEDICARE PTAN
VA1477654473OtherGATEWAY
VA1477654473OtherHEALTHKEEPERS PLUS
VA1477354473OtherHEALTHKEEPERS
VA1477654473OtherINTOTAL
VA1477654473OtherHUMANA MEDICARE
VA1477654473OtherMAJESTACARE
VA1477654473OtherANTHEM
VAVVC734AOtherMEDICARE PTAN
VA1477654473OtherUMWA
VA540506332108OtherTRICARE