Provider Demographics
NPI:1528232683
Name:WADDELL, RYAN LLOYD (DO)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:LLOYD
Last Name:WADDELL
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:4619 KANAWHA AVE SW
Mailing Address - Street 2:PULMONARY ASSOCIATES OF CHARLESTON
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-1319
Mailing Address - Country:US
Mailing Address - Phone:304-400-4545
Mailing Address - Fax:304-400-4546
Practice Address - Street 1:4619 KANAWHA AVE SW
Practice Address - Street 2:PULMONARY ASSOCIATES OF CHARLESTON
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1319
Practice Address - Country:US
Practice Address - Phone:304-400-4545
Practice Address - Fax:304-400-4546
Is Sole Proprietor?:No
Enumeration Date:2008-04-18
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV2879207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103116I522Medicare PIN