Provider Demographics
NPI:1245252311
Name:HERRON, BRYAN R (MD)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:R
Last Name:HERRON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:497 MAIN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-3189
Mailing Address - Country:US
Mailing Address - Phone:410-414-9840
Mailing Address - Fax:410-414-9841
Practice Address - Street 1:497 MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-3189
Practice Address - Country:US
Practice Address - Phone:410-414-9840
Practice Address - Fax:410-414-9841
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD51875207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKCZPOtherBCBS MD
G49259Medicare UPIN
MDKCZPOtherBCBS MD
G49259Medicare UPIN