1922176767 NPI number — PETER A BRYCE MD PC

Table of content: DEMETRIA LORING SMITH LVN (NPI 1598633125)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922176767 NPI number — PETER A BRYCE MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PETER A BRYCE MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922176767
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2296 OPITZ BLVD
Provider Second Line Business Mailing Address:
SUITE 250
Provider Business Mailing Address City Name:
WOODBRIDGE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22191
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-680-5714
Provider Business Mailing Address Fax Number:
703-690-6832

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2296 OPITZ BLVD
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
WOODBRIDGE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22191
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-680-5714
Provider Business Practice Location Address Fax Number:
703-690-6832
Provider Enumeration Date:
12/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BRYCE
Authorized Official First Name:
PETER
Authorized Official Middle Name:
ALEXANDER
Authorized Official Title or Position:
PRESIDENT TREASURER
Authorized Official Telephone Number:
703-680-5714

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  28008 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 28817 . This is a "OPTIMUM CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0004081870 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 006202985 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 285238 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 28817 . This is a "ALLIANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 006159 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 03050001 . This is a "CAREFIRST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 493374 . This is a "NCPPO" identifier . This identifiers is of the category "OTHER".




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