Provider Demographics
NPI:1497878961
Name:CLARK, BRYCHAN KM (MD)
Entity Type:Individual
Prefix:DR
First Name:BRYCHAN
Middle Name:KM
Last Name:CLARK
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Gender:F
Credentials:MD
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Mailing Address - Street 1:130 EXECUTIVE CENTER PKWY
Mailing Address - Street 2:MCGUIRE VA CLINIC FREDERICKSBURG CBOC
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3100
Mailing Address - Country:US
Mailing Address - Phone:540-370-4468
Mailing Address - Fax:540-370-6048
Practice Address - Street 1:130 EXECUTIVE CENTER PKWY
Practice Address - Street 2:MCGUIRE VA CLINIC FREDERICKSBURG CBOC
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3100
Practice Address - Country:US
Practice Address - Phone:540-370-4468
Practice Address - Fax:540-370-6048
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2016-03-23
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Provider Licenses
StateLicense IDTaxonomies
FLME 82925207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease