Provider Demographics
NPI:1720183015
Name:RYAN, THOMAS BALDWIN (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:BALDWIN
Last Name:RYAN
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 1:3000 PRYTANIA ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-3315
Mailing Address - Country:US
Mailing Address - Phone:504-897-2600
Mailing Address - Fax:504-832-5500
Practice Address - Street 1:3040 33RD ST
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-2036
Practice Address - Country:US
Practice Address - Phone:504-832-5500
Practice Address - Fax:504-832-5531
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA013269174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1194395Medicaid
LA7847263OtherAETNA
LA5K986Medicare ID - Type UnspecifiedMEDICARE
LA1194395Medicaid