Provider Demographics
NPI:1073589677
Name:BRYANT, STEPHEN R (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:R
Last Name:BRYANT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:STEPHEN
Other - Middle Name:R
Other - Last Name:BRYANT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:514 W ATLANTIC ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HILL
Mailing Address - State:VA
Mailing Address - Zip Code:23970-1906
Mailing Address - Country:US
Mailing Address - Phone:434-447-6969
Mailing Address - Fax:434-447-8173
Practice Address - Street 1:514 W ATLANTIC ST
Practice Address - Street 2:
Practice Address - City:SOUTH HILL
Practice Address - State:VA
Practice Address - Zip Code:23970-1906
Practice Address - Country:US
Practice Address - Phone:434-447-6969
Practice Address - Fax:434-447-8173
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101026281208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007610874Medicaid
VA1073589677Medicaid
VA007610327Medicaid
VA010288134Medicaid
VA007610327Medicaid
VA493869Medicare Oscar/Certification
VA493833Medicare Oscar/Certification
VA1073589677Medicaid
VA010288134Medicaid
VA007610874Medicaid
VAC03575Medicare PIN
VA023054S75Medicare PIN
VAC10912Medicare PIN