Provider Demographics
NPI:1740205749
Name:RYAN, EMILY A (DO)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:A
Last Name:RYAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 MOHAWK DR
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-2227
Mailing Address - Country:US
Mailing Address - Phone:734-262-3785
Mailing Address - Fax:
Practice Address - Street 1:114 WOODLAND ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1208
Practice Address - Country:US
Practice Address - Phone:860-714-4088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015327207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI494899711Medicaid
010H262530OtherBLUE CROSS-BLUE CROSS
ER015327OtherCHAMPUS-CHAMPUS
ER015327OtherCOMMERCIAL-COMMERCIAL NUMBER
ER015327OtherCOMMERCIAL-COMMERCIAL NUMBER
010H262530OtherBLUE CROSS-BLUE CROSS