Provider Demographics
NPI:1447290580
Name:LONGSTRETH, RYAN WESLEY (MD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:WESLEY
Last Name:LONGSTRETH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1320 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055
Mailing Address - Country:US
Mailing Address - Phone:220-564-4151
Mailing Address - Fax:220-564-7153
Practice Address - Street 1:1320 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055
Practice Address - Country:US
Practice Address - Phone:220-564-4151
Practice Address - Fax:220-564-7153
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35082461207P00000X
OH35082461-L207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2407318Medicaid
OHH85226Medicare UPIN
OH2407318Medicaid