Provider Demographics
NPI:1205804085
Name:RYAN, RUTH ALLISON (MD)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:ALLISON
Last Name:RYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 CONZ ST
Mailing Address - Street 2:#101
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3881
Mailing Address - Country:US
Mailing Address - Phone:413-586-2230
Mailing Address - Fax:413-586-3379
Practice Address - Street 1:90 CONZ ST
Practice Address - Street 2:#101
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3881
Practice Address - Country:US
Practice Address - Phone:413-586-2230
Practice Address - Fax:413-586-3379
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA521452084N0400X, 2084N0600X, 2084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6674OtherBMC
MA16106OtherHEALTH NEW ENGLAND
MA2486136OtherAETNA
MAJ02814OtherBCBSMA
MA6156801OtherCIGNA
MA521451OtherCONNECTICARE
MA6178472Medicaid
MAAA46666OtherHARVARD PILGRIM
MA756081OtherTUFTS
MAJ02814Medicare PIN
MAAA46666OtherHARVARD PILGRIM
MA756081OtherTUFTS