Individual
RYAN DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
50 WASON AVE FL 2, SPRINGFIELD, MA 01107-1280
(413) 794-1800
Mailing address
225 BRIDGE ST, GROTON, CT 06340-3710
(860) 917-8031
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
3466
CT
363AS0400X
Surgical Physician Assistant
PA101950
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004002358
—
CT
Enumeration date
10/29/2015
Last updated
10/09/2025
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