Provider Demographics
NPI:1013126564
Name:PANGAN, RYANN ACQUINO (MD)
Entity Type:Individual
Prefix:DR
First Name:RYANN
Middle Name:ACQUINO
Last Name:PANGAN
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:PO BOX 2379
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-2379
Mailing Address - Country:US
Mailing Address - Phone:606-408-6200
Mailing Address - Fax:606-408-6612
Practice Address - Street 1:613 23RD ST STE 130
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2876
Practice Address - Country:US
Practice Address - Phone:606-329-9335
Practice Address - Fax:606-324-6383
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY42430207RN0300X, 207RN0300X
MI4301083407207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2949582Medicaid
WV3810015249Medicaid
KY7100083160Medicaid
KY1489312Medicare PIN
KY7100083160Medicaid
OHH068570Medicare PIN