Provider Demographics
NPI:1659360592
Name:EASTON, BRIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:EASTON
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:PO BOX 2377
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:VA
Mailing Address - Zip Code:24266-2377
Mailing Address - Country:US
Mailing Address - Phone:276-889-3700
Mailing Address - Fax:276-889-5505
Practice Address - Street 1:495 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:VA
Practice Address - Zip Code:24266
Practice Address - Country:US
Practice Address - Phone:276-889-3700
Practice Address - Fax:276-889-5505
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058953207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1659360592Medicaid
VA020177300OtherFEDERAL BLACK LUNG
VA005605687Medicaid
VA020177300OtherFEDERAL BLACK LUNG
H17451Medicare UPIN
VAVVI334AMedicare PIN