Basic Information
| Provider Information | |||||||||
| NPI: | 1679539522 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CICENAS | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 106 HUFFARD DR | ||||||||
| Address2: | |||||||||
| City: | BLUEFIELD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 246059209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2763223427 | ||||||||
| FaxNumber: | 2763224640 | ||||||||
| Practice Location | |||||||||
| Address1: | 205 MARION PIKE | ||||||||
| Address2: | |||||||||
| City: | COAL GROVE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456383165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405321188 | ||||||||
| FaxNumber: | 7405321183 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2006 | ||||||||
| LastUpdateDate: | 09/27/2019 | ||||||||
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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 | 35.134827 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 21594 | WV | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 21594 | WV | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 35.134827 | OH | N | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 010097096 | 05 | VA | MEDICAID | 1679539522 | 05 | WV | MEDICAID |