Provider Demographics
NPI:1952636730
Name:RYAN, ADAM T (MD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:T
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:DEPARTMENT OF RADIOLOGY STONY BROOK MEDICINE
Mailing Address - Street 2:HSC, LEVEL 4, ROOM 120
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8460
Mailing Address - Country:US
Mailing Address - Phone:631-444-2484
Mailing Address - Fax:631-444-7538
Practice Address - Street 1:DEPARTMENT OF RADIOLOGY STONY BROOK MEDICINE
Practice Address - Street 2:HSC, LEVEL 4, ROOM 120
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8460
Practice Address - Country:US
Practice Address - Phone:631-444-2484
Practice Address - Fax:631-444-7538
Is Sole Proprietor?:No
Enumeration Date:2009-10-12
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT195342207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine