Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 047679149 | CT |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 88123 | GA |
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | D83114 | MD |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | 88123 | GA |
NPI | 1346567369 |
---|---|
Provider Name | Marisa Ann Ryan |
First Address | Middle River, MD 21220-2004 |
Second Address | Baltimore, MD 21287-0005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2010 |
Last Update Date | 04/08/2021 |