Provider Demographics
NPI:1811017874
Name:DR. JERON RYAN PC
Entity Type:Organization
Organization Name:DR. JERON RYAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERON
Authorized Official - Middle Name:
Authorized Official - Last Name:SKERRITT-RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-559-3668
Mailing Address - Street 1:3311 TOLEDO TER
Mailing Address - Street 2:SUITE C-102
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-4135
Mailing Address - Country:US
Mailing Address - Phone:301-559-3668
Mailing Address - Fax:301-559-0670
Practice Address - Street 1:3311 TOLEDO TER
Practice Address - Street 2:SUITE C-102
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-4135
Practice Address - Country:US
Practice Address - Phone:301-559-3668
Practice Address - Fax:301-559-0670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12037261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental