Provider Demographics
NPI:1356662001
Name:TAMIKO A. BRYANT, MD,LLC
Entity Type:Organization
Organization Name:TAMIKO A. BRYANT, MD,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMIKO
Authorized Official - Middle Name:ANDREA
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-245-3484
Mailing Address - Street 1:17001 SCIENCE DRIVE
Mailing Address - Street 2:#118
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715
Mailing Address - Country:US
Mailing Address - Phone:240-245-3484
Mailing Address - Fax:240-245-3486
Practice Address - Street 1:17001 SCIENCE DR
Practice Address - Street 2:#118
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-4329
Practice Address - Country:US
Practice Address - Phone:240-245-3484
Practice Address - Fax:240-245-3486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-17
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0054820207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCV944OtherBCBS
MDCR7WTAOtherBCBS
MD003388000Medicaid
MD454L0276Medicare PIN
MD003388000Medicaid
MD796MMedicare PIN
MDH00347Medicare UPIN