Provider Demographics
NPI:1689681587
Name:RYAN, KATHRYN (DO)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:101 ALWINE RD
Mailing Address - Street 2:STE 104
Mailing Address - City:SAXONBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16056-8604
Mailing Address - Country:US
Mailing Address - Phone:724-352-8840
Mailing Address - Fax:724-352-9033
Practice Address - Street 1:101 ALWINE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:SAXONBURG
Practice Address - State:PA
Practice Address - Zip Code:16056-8604
Practice Address - Country:US
Practice Address - Phone:724-352-8840
Practice Address - Fax:724-352-9033
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS006084L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F50713Medicare UPIN