Provider Demographics
NPI:1356721054
Name:WASHINGTON, BRIAN
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 W KING ST
Mailing Address - Street 2:UNIT C
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-2488
Mailing Address - Country:US
Mailing Address - Phone:484-927-6177
Mailing Address - Fax:
Practice Address - Street 1:147 W KING ST
Practice Address - Street 2:UNIT C
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-2488
Practice Address - Country:US
Practice Address - Phone:484-927-6177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator