Provider Demographics
NPI:1376750133
Name:BRYAN, CANDACE VICTORIA (MD)
Entity Type:Individual
Prefix:DR
First Name:CANDACE
Middle Name:VICTORIA
Last Name:BRYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 HAMAKER CT
Mailing Address - Street 2:SUITE #400
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2238
Mailing Address - Country:US
Mailing Address - Phone:703-876-0800
Mailing Address - Fax:703-876-0866
Practice Address - Street 1:3020 HAMAKER CT
Practice Address - Street 2:SUITE #400
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2238
Practice Address - Country:US
Practice Address - Phone:703-876-0800
Practice Address - Fax:703-876-0866
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012420562084B0040X
VA0101240562084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & Neuropsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1376750133Medicaid
VA022126N42Medicare PIN