Basic Information
| Provider Information | |||||||||
| NPI: | 1477653152 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RYAN | ||||||||
| FirstName: | TARA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6918 PALACE CT | ||||||||
| Address2: | |||||||||
| City: | FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217032743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016940342 | ||||||||
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| Practice Location | |||||||||
| Address1: | 111 PARK AVE | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212013402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108375533 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | D0063338 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD035555 | DC | N | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.