Provider Demographics
NPI:1821276866
Name:RYAN, LAWRENCE BRIELMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:BRIELMAN
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 1:106 ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-4818
Mailing Address - Country:US
Mailing Address - Phone:757-377-3801
Mailing Address - Fax:804-643-6789
Practice Address - Street 1:117 S 3RD ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-3703
Practice Address - Country:US
Practice Address - Phone:804-643-6789
Practice Address - Fax:804-643-6799
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101231458208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101231458OtherVA MED LICENSE
VA0101231458OtherVA MED LICENSE