Provider Demographics
NPI:1689781197
Name:WELLS, BRIAN CHRISTOPHER (PA-C)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:CHRISTOPHER
Last Name:WELLS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 12TH ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-3722
Mailing Address - Country:US
Mailing Address - Phone:202-271-0506
Mailing Address - Fax:
Practice Address - Street 1:1901 E ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-2528
Practice Address - Country:US
Practice Address - Phone:202-271-0506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPA030458363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical