Provider Demographics
NPI:1346340502
Name:WILLARD, BRIAN MCKINLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:MCKINLEY
Last Name:WILLARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1108 VAN BUREN RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-2034
Mailing Address - Country:US
Mailing Address - Phone:610-253-2968
Mailing Address - Fax:610-253-2516
Practice Address - Street 1:1108 VAN BUREN RD
Practice Address - Street 2:SUITE 202
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-2034
Practice Address - Country:US
Practice Address - Phone:610-253-2968
Practice Address - Fax:610-253-2516
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD049155L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001437123004Medicaid
PA001437123004Medicaid
F50885Medicare UPIN