Provider Demographics
NPI:1275501736
Name:MCEACHERN, BRYAN WALLACE (MD, FAAP)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:WALLACE
Last Name:MCEACHERN
Suffix:
Gender:M
Credentials:MD, FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9001 DIGGES RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4421
Mailing Address - Country:US
Mailing Address - Phone:703-392-5437
Mailing Address - Fax:703-392-0176
Practice Address - Street 1:9001 DIGGES RD
Practice Address - Street 2:SUITE 106
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4421
Practice Address - Country:US
Practice Address - Phone:703-392-5437
Practice Address - Fax:703-392-0176
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101051497208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006724264Medicaid
VA006724264Medicaid
VA006724264Medicaid