Basic Information
| Provider Information | |||||||||
| NPI: | 1154312379 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RYAN | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 143 LONGWATER DR | ||||||||
| Address2: | |||||||||
| City: | NORWELL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020611683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818785200 | ||||||||
| FaxNumber: | 7817922971 | ||||||||
| Practice Location | |||||||||
| Address1: | 143 LONGWATER DR | ||||||||
| Address2: | |||||||||
| City: | NORWELL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020611683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818785200 | ||||||||
| FaxNumber: | 7817922971 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2005 | ||||||||
| LastUpdateDate: | 12/21/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 220592 | MA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 43283986 | 01 | UNITED | OTHER | AA17474 | 01 | MA | HPHC | OTHER | 469892 | 01 | MA | TUFTS HEALTH CARE | OTHER | 8688067 | 01 | MA | CIGNA | OTHER | 7272621 | 01 | MA | AETNA | OTHER | 91246 | 01 | MA | FALLON | OTHER | 1154312379 | 01 | MA | NEIGHBORHOOD HEALTH PLAN | OTHER | 469892 | 01 | MA | TUFTS MEDICARE PREFERRED | OTHER | 042297845 | 01 | MA | TRICARE | OTHER | 2085861 | 05 | MA | MEDICAID | J28136 | 01 | MA | BCBS | OTHER | 042297845 | 01 | MA | UNITED HEALTH CARE | OTHER |