Provider Demographics
NPI:1568105351
Name:NYE, DEREK MICHAEL RYAN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:MICHAEL RYAN
Last Name:NYE
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 THRUSH DRIVE
Mailing Address - Street 2:
Mailing Address - City:HUMMELSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17036
Mailing Address - Country:US
Mailing Address - Phone:646-535-3276
Mailing Address - Fax:
Practice Address - Street 1:300 BROOKLINE AVENUE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215
Practice Address - Country:US
Practice Address - Phone:617-667-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program