Provider Demographics
NPI:1871613364
Name:DAVIS, RYAN KORY (MD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:KORY
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 O'LEARY WAY 83
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3759
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6 OLEARY WAY
Practice Address - Street 2:83
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-3759
Practice Address - Country:US
Practice Address - Phone:617-667-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2250822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry