Provider Demographics
NPI:1821256876
Name:CARROLL, RYAN WESLEY (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:WESLEY
Last Name:CARROLL
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Gender:M
Credentials:MD, MPH
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Mailing Address - Street 1:4 EMERSON PL
Mailing Address - Street 2:APT 704
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2275
Mailing Address - Country:US
Mailing Address - Phone:773-332-8178
Mailing Address - Fax:
Practice Address - Street 1:175 CAMBRIDGE ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2743
Practice Address - Country:US
Practice Address - Phone:617-724-4380
Practice Address - Fax:617-724-4391
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2010-11-01
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Provider Licenses
StateLicense IDTaxonomies
IL036-1139992080P0203X
MA2457502080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine