Individual
MR. RYAN GREGORY BASHOUR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
55 FRUIT ST, BOSTON, MA 02114-2696
(617) 726-2000
Mailing address
21 PYRAMID DR APT 511, HUNTINGTON, WV 25705-3267
(304) 376-2815
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA
—
363A00000X
Physician Assistant
Primary
—
—
363AM0700X
Medical Physician Assistant
PA101752
MA
363AM0700X
Medical Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
—
—
Other
Enumeration date
07/26/2023
Last updated
02/04/2026
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