Provider Demographics
NPI:1649292376
Name:RYAN, COLLEEN (MD)
Entity type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1385 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40208-2305
Mailing Address - Country:US
Mailing Address - Phone:502-558-3192
Mailing Address - Fax:502-409-8369
Practice Address - Street 1:MADISON STATE HOSPITAL
Practice Address - Street 2:711 GREEN RD.
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250
Practice Address - Country:US
Practice Address - Phone:812-265-7336
Practice Address - Fax:812-265-7487
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01035114A2084A0401X
KY379772084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64073943Medicaid