Provider Demographics
NPI:1255493110
Name:BRYCE, PETER ALEXANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:ALEXANDER
Last Name:BRYCE
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 1:2296 OPITZ BLVD
Mailing Address - Street 2:SUITE #250
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3300
Mailing Address - Country:US
Mailing Address - Phone:703-680-5714
Mailing Address - Fax:703-680-1014
Practice Address - Street 1:2296 OPITZ BLVD
Practice Address - Street 2:SUITE #250
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3300
Practice Address - Country:US
Practice Address - Phone:703-680-5714
Practice Address - Fax:703-680-1014
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA28008207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006202985Medicaid
VA285238OtherAMERIGROUP
521123277OtherCIGNA
VA03050001OtherCAREFIRST
28817OtherALLIANCE
493374OtherNCPPO
VA0004081870OtherAETNA
06159OtherANTHEM
VA285238OtherAMERIGROUP
VA0004081870OtherAETNA