Provider Demographics
NPI:1962488668
Name:RYAN, MICHAEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:RYAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:885 KEMPSVILLE RD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3800
Mailing Address - Country:US
Mailing Address - Phone:757-466-0165
Mailing Address - Fax:757-466-7296
Practice Address - Street 1:885 KEMPSVILLE RD
Practice Address - Street 2:SUITE 114
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3800
Practice Address - Country:US
Practice Address - Phone:757-466-0165
Practice Address - Fax:757-466-7296
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2007-08-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101036589207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1659563799OtherGROUP NPI
VA541870984-008OtherCIGNA
NC8906542Medicaid
VA4004834OtherAETNA
VA15124OtherOPTIMA
VA5807751Medicaid
VA323627OtherANTHEM BCBS
VAB09598Medicare UPIN