Provider Demographics
NPI:1659633659
Name:FLANNERY, RYAN GARRETT (MD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:GARRETT
Last Name:FLANNERY
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 1:2580 HAYMAKER RD STE 403
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-3500
Mailing Address - Country:US
Mailing Address - Phone:724-325-1455
Mailing Address - Fax:724-325-1192
Practice Address - Street 1:2580 HAYMAKER RD STE 403
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3500
Practice Address - Country:US
Practice Address - Phone:724-325-1455
Practice Address - Fax:724-325-1192
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD444220207LP2900X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0069038Medicaid
WV3810010045Medicaid
PA102732523Medicaid
OH0069038Medicaid