Provider Demographics
NPI:1568460079
Name:MADANICK, RYAN DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:DAVID
Last Name:MADANICK
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:UNC SCHOOL OF MEDICINE DIVISION OF GI HEPATOLOGY
Mailing Address - Street 2:CB# 7080
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7080
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:UNC SCHOOL OF MEDICINE DIVISION OF GI HEPATOLOGY
Practice Address - Street 2:CB# 7080
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-7080
Practice Address - Country:US
Practice Address - Phone:919-966-2513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 89770207RG0100X
NC207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5905447Medicaid
NC2061052Medicare ID - Type Unspecified
FLI08105Medicare UPIN
NC5905447Medicaid
NCI08105Medicare UPIN