Provider Demographics
NPI:1629037288
Name:RYAN, SEAN V (MD)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:V
Last Name:RYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 252
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010
Mailing Address - Country:US
Mailing Address - Phone:610-436-6529
Mailing Address - Fax:610-436-6479
Practice Address - Street 1:830 OLD LANCASTER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3118
Practice Address - Country:US
Practice Address - Phone:610-527-1185
Practice Address - Fax:610-527-8759
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD071029L2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1009932900001Medicaid
PA1009932900001Medicaid
I05927Medicare UPIN