Provider Demographics
NPI:1558568170
Name:WALKER, RYAN MCGARRY (MD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:MCGARRY
Last Name:WALKER
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 1:105 COUNTY ROUTE 45A STE 100
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-6665
Mailing Address - Country:US
Mailing Address - Phone:315-342-6771
Mailing Address - Fax:315-342-2842
Practice Address - Street 1:105 COUNTY ROUTE 45A STE 100
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-6665
Practice Address - Country:US
Practice Address - Phone:315-342-6771
Practice Address - Fax:315-342-2842
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY272867208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03769573Medicaid
NY03769573Medicaid