Individual
KEVIN RYAN FREE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3930 WALNUT ST STE 101, FAIRFAX, VA 22030-4750
(703) 246-9246
(703) 246-9257
Mailing address
3930 WALNUT ST STE 101, FAIRFAX, VA 22030-4750
(703) 246-9246
(703) 246-9257
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0110009144
VA
363AM0700X
Medical Physician Assistant
C04779
MD
Other
Enumeration date
06/18/2012
Last updated
08/09/2023
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