Provider Demographics
NPI:1871007187
Name:MCCUNE, RYAN A (PA)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:A
Last Name:MCCUNE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:416 COLEGATE DR BLDG 3
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-9549
Mailing Address - Country:US
Mailing Address - Phone:740-568-4814
Mailing Address - Fax:740-374-3165
Practice Address - Street 1:400 MATTHEW ST STE 302
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-1656
Practice Address - Country:US
Practice Address - Phone:740-568-5207
Practice Address - Fax:740-568-5297
Is Sole Proprietor?:No
Enumeration Date:2017-11-22
Last Update Date:2022-08-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WV2115363A00000X
OH50.007378RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2115OtherWV BOARD OF MEDICINE