Provider Demographics
NPI:1679539522
Name:CICENAS, RYAN R (MD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:R
Last Name:CICENAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1680
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25717-1680
Mailing Address - Country:US
Mailing Address - Phone:304-781-5159
Mailing Address - Fax:304-523-8115
Practice Address - Street 1:111 GREAT TEAYS BLVD STE 101
Practice Address - Street 2:
Practice Address - City:SCOTT DEPOT
Practice Address - State:WV
Practice Address - Zip Code:25560-9548
Practice Address - Country:US
Practice Address - Phone:304-757-8803
Practice Address - Fax:304-757-6904
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35.134827207R00000X, 208000000X
WV21594208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0318066Medicaid
VA010097096Medicaid
WV1679539522Medicaid