Provider Demographics
NPI:1922176767
Name:PETER A BRYCE MD PC
Entity Type:Organization
Organization Name:PETER A BRYCE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:BRYCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-680-5714
Mailing Address - Street 1:2296 OPITZ BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191
Mailing Address - Country:US
Mailing Address - Phone:703-680-5714
Mailing Address - Fax:703-690-6832
Practice Address - Street 1:2296 OPITZ BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191
Practice Address - Country:US
Practice Address - Phone:703-680-5714
Practice Address - Fax:703-690-6832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA28008207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
28817OtherOPTIMUM CHOICE
0004081870OtherAETNA
VA006202985Medicaid
285238OtherAMERIGROUP
28817OtherALLIANCE
006159OtherANTHEM
03050001OtherCAREFIRST
493374OtherNCPPO
285238OtherAMERIGROUP
VA006202985Medicaid
03050001OtherCAREFIRST
493374OtherNCPPO