Provider Demographics
NPI:1902336977
Name:SMITH, RYAN KENNETH (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:KENNETH
Last Name:SMITH
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 1:1450 CHAPEL STREET
Mailing Address - Street 2:SRC ADULT PRIMARY CARE CLINIC
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511
Mailing Address - Country:US
Mailing Address - Phone:203-789-4044
Mailing Address - Fax:
Practice Address - Street 1:1450 CHAPEL STREET
Practice Address - Street 2:SRC ADULT PRIMARY CARE CLINIC
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511
Practice Address - Country:US
Practice Address - Phone:203-789-4044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program