Basic Information
| Provider Information | |||||||||
| NPI: | 1205804085 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RYAN | ||||||||
| FirstName: | RUTH | ||||||||
| MiddleName: | ALLISON | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 90 CONZ ST | ||||||||
| Address2: | #101 | ||||||||
| City: | NORTHAMPTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010603881 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135862230 | ||||||||
| FaxNumber: | 4135863379 | ||||||||
| Practice Location | |||||||||
| Address1: | 90 CONZ ST | ||||||||
| Address2: | #101 | ||||||||
| City: | NORTHAMPTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010603881 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135862230 | ||||||||
| FaxNumber: | 4135863379 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2006 | ||||||||
| LastUpdateDate: | 06/05/2008 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 52145 | MA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0600X | 52145 | MA | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Clinical Neurophysiology | 2084P2900X | 52145 | MA | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 6674 | 01 | MA | BMC | OTHER | 16106 | 01 | MA | HEALTH NEW ENGLAND | OTHER | 2486136 | 01 | MA | AETNA | OTHER | J02814 | 01 | MA | BCBSMA | OTHER | 6156801 | 01 | MA | CIGNA | OTHER | 521451 | 01 | MA | CONNECTICARE | OTHER | 6178472 | 05 | MA | MEDICAID | AA46666 | 01 | MA | HARVARD PILGRIM | OTHER | 756081 | 01 | MA | TUFTS | OTHER |