Individual
COLLEEN E RYAN
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1350 MAIN ST, WALPOLE, MA 02081-1718
(508) 668-2200
(508) 668-6539
Mailing address
1350 MAIN ST, WALPOLE, MA 02081-1718
(508) 668-2200
(508) 668-6539
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
79455
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
079455
TUFTS
—
01
—
200481
HPHC
—
01
—
3125998
MEDICAID-MA
—
05
—
3125998
—
MA
01
—
36145
CMSP/HSP
—
01
—
4514287
AETNA/US HEALTHCARE
—
01
—
79455
MEDICAL LIC
—
01
—
920717
AETNA/US HEALTHCARE HMO
—
01
—
9314935
CIGNA
—
01
—
J14629
BCBS-MA
—
01
—
P2967576
OXFORD
—
Enumeration date
08/15/2005
Last updated
07/08/2007
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