Basic Information
| Provider Information | |||||||||
| NPI: | 1427016591 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RYAN | ||||||||
| FirstName: | FRANK | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 12805 LOST LAKE CIR | ||||||||
| Address2: | |||||||||
| City: | FORT WASHINGTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207446307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | |||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 11701 LIVINGSTON RD | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | FORT WASHINGTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207445104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012927270 | ||||||||
| FaxNumber: | 3012030740 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2006 | ||||||||
| LastUpdateDate: | 04/02/2009 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | D0019431 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0400752 | 01 | MD | EVERCARE | OTHER | 0780385 | 01 | MH | AETNA US HEALTHCARE | OTHER | 1417045013 | 01 | MH | CIGNA | OTHER | 9711 | 01 | MD | KAISER | OTHER | 0400048 | 01 | MD | UNTD HLTHC AMERI-CHOICE | OTHER | 25970007 | 01 | DC | BCBSNCA | OTHER | 521973185 | 01 | MD | PHCS | OTHER | 26667100 | 05 | DC | MEDICAID | 498199 | 01 | MD | NCPPO | OTHER | 4053590 | 01 | MD | AETNA | OTHER | 42021409 | 01 | MD | BCBS OF MARYLAND | OTHER | 02133000000 | 01 | MH | PREFERRED HEALTH | OTHER | 256066 | 01 | MD | MAMSI/ALLIANCE | OTHER | 521973185 | 01 | MD | FIDELITY PMG | OTHER | 521973185 | 01 | MD | UNITED HEALTHCARE | OTHER | 973631000 | 05 | MD | MEDICAID |