Provider Demographics
NPI:1780678649
Name:RYAN, ANNA (MD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 MAIN ST 302
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-3301
Mailing Address - Country:US
Mailing Address - Phone:978-849-7507
Mailing Address - Fax:978-371-0522
Practice Address - Street 1:1650 ELM ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1217
Practice Address - Country:US
Practice Address - Phone:603-626-7546
Practice Address - Fax:603-626-7548
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH9710174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHG26516Medicare UPIN
NHRE4109Medicare ID - Type Unspecified