Basic Information
| Provider Information | |||||||||
| NPI: | 1235142480 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCANNELL | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 85 SPRING ST | ||||||||
| Address2: | |||||||||
| City: | LACONIA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 032463113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035247402 | ||||||||
| FaxNumber: | 6035240945 | ||||||||
| Practice Location | |||||||||
| Address1: | 189A HIGH ST | ||||||||
| Address2: | |||||||||
| City: | NEWBURYPORT | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019503864 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036307333 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2006 | ||||||||
| LastUpdateDate: | 11/18/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 13643 | NH | Y | Other Service Providers | Specialist | 207Y00000X | 13643 | NH | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207YX0602X | 13643 | NH | N | Allopathic & Osteopathic Physicians | Otolaryngology | Otolaryngic Allergy | 207YS0123X | 13643 | NH | N | Allopathic & Osteopathic Physicians | Otolaryngology | Facial Plastic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 7976870 | 01 | AETNA | OTHER | I67437 | 01 | ACS/HEALTHNET OF NE | OTHER | 30207005 | 05 | NH | MEDICAID | 01Y012271NH01 | 01 | BCBS | OTHER | 0742513 | 01 | CIGNA | OTHER | 9607945 | 01 | GHI | OTHER | AA95773 | 01 | HARVARD PILGRIM | OTHER |