Provider Demographics
NPI:1467434886
Name:CARTY, BRIAN CLIFFORD (MD)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:CLIFFORD
Last Name:CARTY
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 1:3111 TELEGRAPH CORNER LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-2359
Mailing Address - Country:US
Mailing Address - Phone:703-317-3200
Mailing Address - Fax:703-317-3231
Practice Address - Street 1:3111 TELEGRAPH CORNER LN
Practice Address - Street 2:SUITE 100
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-2359
Practice Address - Country:US
Practice Address - Phone:703-317-3200
Practice Address - Fax:703-317-3231
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049697207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5620988Medicaid
00A318T16Medicare ID - Type Unspecified
VA5620988Medicaid