Provider Demographics
NPI:1629202056
Name:BRYAN, WILSON WERBER (MD)
Entity Type:Individual
Prefix:
First Name:WILSON
Middle Name:WERBER
Last Name:BRYAN
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 1:10730 PINE HAVEN TER
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3441
Mailing Address - Country:US
Mailing Address - Phone:301-496-8969
Mailing Address - Fax:301-480-0056
Practice Address - Street 1:10 CENTER DR
Practice Address - Street 2:BUILDING 10, ROOM 5S-219
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-0001
Practice Address - Country:US
Practice Address - Phone:301-496-8969
Practice Address - Fax:301-480-0056
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00580722084N0008X, 2084N0400X, 2084N0600X
TXG79172084N0008X, 2084N0400X, 2084N0600X
VA01012320402084N0008X, 2084N0400X, 2084N0600X
DCMD334512084N0008X, 2084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular Medicine
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF38514Medicare UPIN