Provider Demographics
NPI:1710242219
Name:BRYANT, MATTHEW EARLE (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:EARLE
Last Name:BRYANT
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 1:146 S MAIN ST STE 3
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24450-2356
Mailing Address - Country:US
Mailing Address - Phone:540-463-9158
Mailing Address - Fax:540-463-4218
Practice Address - Street 1:146 S MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:VA
Practice Address - Zip Code:24450
Practice Address - Country:US
Practice Address - Phone:540-463-9158
Practice Address - Fax:540-463-4218
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101255862207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine