Individual
CRAIG RYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1 ROYCE CIR, SUITE 104, STORRS MANSFIELD, CT 06268-2260
(860) 487-9200
(860) 487-9222
Mailing address
263 FARMINGTON AVE, PROVIDER ENROLLMENT, FARMINGTON, CT 06030-2212
(860) 679-7503
(860) 679-1610
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
000311
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000311
CT LIC #
CT
05
—
1073581401
—
CT
Enumeration date
03/10/2006
Last updated
01/13/2023
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