Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | MD441695 | PA |
N | 208600000X | Surgeon | MD441695 | PA |
N | 208200000X | Surgeon | MT188082 | PA |
N | 208600000X | Surgeon | MT188082 | PA |
Y | 2086S0102X | Surgical Critical Care | MD441695 | PA |
N | 2086S0102X | Surgical Critical Care | ME114014 | FL |
NPI | 1174783013 |
---|---|
Provider Name | Dr. Ryan Marc Shadis |
First Address | Abington, PA 19001-3727 |
Second Address | Abington, PA 19001-3727 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2008 |
Last Update Date | 21/08/2013 |