Provider Demographics
NPI:1710581798
Name:RAFFERTY, RYAN SCOTT (PA-C)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:SCOTT
Last Name:RAFFERTY
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:301 LIPPINCOTT DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:856-546-3900
Mailing Address - Fax:856-546-3908
Practice Address - Street 1:120 WHITE HORSE PIKE STE 103B
Practice Address - Street 2:
Practice Address - City:HADDON HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08035-1938
Practice Address - Country:US
Practice Address - Phone:856-546-3900
Practice Address - Fax:856-546-3908
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2022-09-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMA061962363A00000X
NJ25MP00602500363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant