Provider Demographics
NPI:1265403737
Name:COLELLA, RYAN L (MD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:L
Last Name:COLELLA
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 1:2401 E EVESHAM RD STE A1
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-9590
Mailing Address - Country:US
Mailing Address - Phone:856-424-3323
Mailing Address - Fax:856-424-4994
Practice Address - Street 1:2401 E EVESHAM RD
Practice Address - Street 2:SUITE A
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-9590
Practice Address - Country:US
Practice Address - Phone:856-424-3323
Practice Address - Fax:856-424-4994
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA068283207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G86967Medicare UPIN
NJ023795N5TMedicare PIN