Provider Demographics
NPI:1649439068
Name:RYER, EVAN JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:EVAN
Middle Name:JOSEPH
Last Name:RYER
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 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:
Practice Address - Street 1:100 N ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17822-2770
Practice Address - Country:US
Practice Address - Phone:570-271-6369
Practice Address - Fax:570-271-5840
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235057-1208600000X
MN523562086S0129X
MN1044712086S0129X
PAMD4424122086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNENROLLEDMedicaid
PA102623000Medicaid
IAENROLLEDMedicaid
MNP00873617OtherRAILROAD MEDICARE
MN770000117Medicare PIN