Provider Demographics
NPI:1235388679
Name:BRYANT, JUANITA SONYA (MD)
Entity Type:Individual
Prefix:DR
First Name:JUANITA
Middle Name:SONYA
Last Name:BRYANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:7501 GREENWAY CENTER DR
Mailing Address - Street 2:#300
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3514
Mailing Address - Country:US
Mailing Address - Phone:301-474-4679
Mailing Address - Fax:301-474-7182
Practice Address - Street 1:660 PENNSYLVANIA AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-4346
Practice Address - Country:US
Practice Address - Phone:202-331-1188
Practice Address - Fax:202-833-8872
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA103452207W00000X
DCMD040362207W00000X, 207WX0107X
MDD073928207WX0107X
VA0101251552207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC092018700Medicaid
CAA103452OtherTHE MEDICAL BOARD OF CALIFORNIA
VA1235388679Medicaid
VA1235388679Medicaid
DC242438Y2FMedicare PIN