Provider Demographics
NPI:1932775301
Name:ATKINSON, RYAN F (MD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:F
Last Name:ATKINSON
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 1:723 ROBINHOOD RD
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD FOREST
Mailing Address - State:MD
Mailing Address - Zip Code:21405-2021
Mailing Address - Country:US
Mailing Address - Phone:443-822-5887
Mailing Address - Fax:
Practice Address - Street 1:611 W PARK ST
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-2529
Practice Address - Country:US
Practice Address - Phone:443-822-5887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.078522208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery