Basic Information
| Provider Information | |||||||||
| NPI: | 1639387236 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUCHHOLZ | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3020 14TH ST NW | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200096865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2027454300 | ||||||||
| FaxNumber: | 2027450708 | ||||||||
| Practice Location | |||||||||
| Address1: | 3020 14TH ST NW | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200096865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2027454300 | ||||||||
| FaxNumber: | 2027450708 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2007 | ||||||||
| LastUpdateDate: | 08/20/2009 | ||||||||
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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 | 35091904 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 35091904 | OH | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | MD038167 | DC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 390200000X | TC 57-00-9080 | OH | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208000000X | MD038167 | DC | N | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 2829363 | 05 | OH | MEDICAID |