Provider Demographics
NPI:1366731572
Name:RYAN, ANNE BOWMAN (MD)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:BOWMAN
Last Name:RYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:MICHELLE
Other - Last Name:BOWMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:167 SULLYS TRL
Mailing Address - Street 2:STE 100
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-4567
Mailing Address - Country:US
Mailing Address - Phone:585-758-0800
Mailing Address - Fax:585-381-1577
Practice Address - Street 1:167 SULLYS TRL
Practice Address - Street 2:STE 100
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-4567
Practice Address - Country:US
Practice Address - Phone:585-758-0800
Practice Address - Fax:585-381-1577
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY271348208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04186403Medicaid
NYJ400344358Medicare PIN