Individual
DR. EDWARD THOMAS RYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 FRUIT ST, GRJ 5 INFECTIOUS DISEASE ASSOCIATES, BOSTON, MA 02114-2696
(617) 726-6175
(617) 726-7416
Mailing address
PO BOX 9142, MASS GENERAL PHYSICIAN ORGANIZATION, CHARLESTOWN, MA 02129-9142
(617) 724-6454
(617) 726-7653
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
72191
MA
207RI0200X
Infectious Disease Physician
Primary
72191
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
072191
TUFTS HEALTH PLAN
MA
05
—
3168735
—
MA
01
—
J09931
BCBS MA
MA
Enumeration date
10/24/2005
Last updated
10/23/2012
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