Provider Demographics
NPI:1659581361
Name:RYAN, THOMAS D (MD, PHD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:D
Last Name:RYAN
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 1:3333 BURNET AVE
Mailing Address - Street 2:ML 2003
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229
Mailing Address - Country:US
Mailing Address - Phone:513-636-9282
Mailing Address - Fax:513-636-3952
Practice Address - Street 1:3333 BURNET AVE
Practice Address - Street 2:ML 2003
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229
Practice Address - Country:US
Practice Address - Phone:513-636-9282
Practice Address - Fax:513-636-3952
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0933102080P0202X
KY466972080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology