Provider Demographics
NPI:1558312009
Name:RYAN, TIMOTHY E (DO)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:E
Last Name:RYAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 N MURRAY HILL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-1524
Mailing Address - Country:US
Mailing Address - Phone:614-878-7407
Mailing Address - Fax:614-878-7447
Practice Address - Street 1:108 N MURRAY HILL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-1524
Practice Address - Country:US
Practice Address - Phone:614-878-7407
Practice Address - Fax:614-878-7447
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-4034207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0605849Medicaid
OHE89381Medicare UPIN
OH0605849Medicaid