Provider Demographics
NPI:1083696595
Name:BRYAN, ANGELA J (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:J
Last Name:BRYAN
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 1:2293 SUGAR HILL RD STE D
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-7787
Mailing Address - Country:US
Mailing Address - Phone:828-652-8727
Mailing Address - Fax:828-652-8793
Practice Address - Street 1:2293 SUGAR HILL RD STE D
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-7787
Practice Address - Country:US
Practice Address - Phone:828-652-8727
Practice Address - Fax:828-652-8793
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-01067207Q00000X
NC140142207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1083696595Medicaid
FLH34347Medicare UPIN
FL261947400Medicaid
FL186112OtherSTAYWELL
FL26012OtherBC/BS OF FLORIDA
FL278474OtherAVMED
FL26012AMedicare ID - Type Unspecified