Provider Demographics
NPI:1164598470
Name:EGAN, BRIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:EGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6845 ELM STREET
Mailing Address - Street 2:SUITE 611
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3822
Mailing Address - Country:US
Mailing Address - Phone:703-956-6880
Mailing Address - Fax:703-893-7336
Practice Address - Street 1:6845 ELM STREET
Practice Address - Street 2:SUITE 611
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3822
Practice Address - Country:US
Practice Address - Phone:703-956-6880
Practice Address - Fax:703-893-7336
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD33736207W00000X
VA0101039522207W00000X
DCMD13798207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1164598470Medicaid
DC004026E91Medicare PIN
D29379Medicare UPIN