Provider Demographics
NPI:1891721932
Name:EDWARD F. RYAN,JR. D.O.,LLC
Entity Type:Organization
Organization Name:EDWARD F. RYAN,JR. D.O.,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:610-626-6220
Mailing Address - Street 1:2100 KEYSTONE AVE
Mailing Address - Street 2:SUITE 507
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-1129
Mailing Address - Country:US
Mailing Address - Phone:610-626-6220
Mailing Address - Fax:610-626-3265
Practice Address - Street 1:2100 KEYSTONE AVE
Practice Address - Street 2:STE 507
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-1129
Practice Address - Country:US
Practice Address - Phone:610-626-6220
Practice Address - Fax:610-626-3265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004391-L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC27754Medicare UPIN
PA097620Medicare ID - Type Unspecified