Provider Demographics
NPI:1457043325
Name:RYANS, MINGCOYA VENESE (CSFA)
Entity Type:Individual
Prefix:
First Name:MINGCOYA
Middle Name:VENESE
Last Name:RYANS
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7008 BARNETT LN UNIT 238
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-7410
Mailing Address - Country:US
Mailing Address - Phone:908-884-6383
Mailing Address - Fax:
Practice Address - Street 1:7008 BARNETT LN UNIT 238
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-7410
Practice Address - Country:US
Practice Address - Phone:908-884-6383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21-299208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty