Provider Demographics
NPI:1932301330
Name:RYBAK, NATASHA RENEE (MD)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:RENEE
Last Name:RYBAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 VIRGINIA AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-4406
Mailing Address - Country:US
Mailing Address - Phone:401-443-4992
Mailing Address - Fax:401-784-4902
Practice Address - Street 1:1125 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-5739
Practice Address - Country:US
Practice Address - Phone:401-793-2928
Practice Address - Fax:401-793-7401
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP01215208000000X
RIMD13759207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No208000000XAllopathic & Osteopathic PhysiciansPediatrics