Basic Information
| Provider Information | |||||||||
| NPI: | 1528239951 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RYAN | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 FRANKLIN HEALTH COMMONS | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON | ||||||||
| State: | ME | ||||||||
| PostalCode: | 04938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077786031 | ||||||||
| FaxNumber: | 2077792240 | ||||||||
| Practice Location | |||||||||
| Address1: | 20 HARTFORD ST | ||||||||
| Address2: | |||||||||
| City: | HOULTON | ||||||||
| State: | ME | ||||||||
| PostalCode: | 047301891 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2075322900 | ||||||||
| FaxNumber: | 2075325974 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2008 | ||||||||
| LastUpdateDate: | 08/25/2011 | ||||||||
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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 | 207R00000X | 228303 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 2076 | ME | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.