Provider Demographics
NPI:1932181153
Name:DAMMERMAN, RYAN S (MD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:S
Last Name:DAMMERMAN
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 1:778 1/2 CITY PARK AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43206-2044
Mailing Address - Country:US
Mailing Address - Phone:412-983-5973
Mailing Address - Fax:614-575-9405
Practice Address - Street 1:401 N EWING ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3372
Practice Address - Country:US
Practice Address - Phone:740-687-8000
Practice Address - Fax:740-687-8939
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35084800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35084800OtherOHIO STATE LICENSE
OH2539800Medicaid
OH35084800OtherOHIO STATE LICENSE
OHI17119Medicare UPIN