Provider Demographics
NPI:1396111225
Name:MCKALLAGAT, RYAN
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:
Last Name:MCKALLAGAT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03064-2011
Mailing Address - Country:US
Mailing Address - Phone:603-521-6412
Mailing Address - Fax:603-521-6415
Practice Address - Street 1:14 BROAD ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03064-2011
Practice Address - Country:US
Practice Address - Phone:603-521-6412
Practice Address - Fax:603-521-6415
Is Sole Proprietor?:No
Enumeration Date:2015-08-14
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHH653237700000X
MA307237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist