Provider Demographics
NPI:1801906938
Name:FORD, MARY BRYANT (CRNA)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:BRYANT
Last Name:FORD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:BRYANT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 91734
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23291-1734
Mailing Address - Country:US
Mailing Address - Phone:804-358-6100
Mailing Address - Fax:804-342-7619
Practice Address - Street 1:1250 E MARSHALL ST
Practice Address - Street 2:ANESTHESIA CRNA
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5051
Practice Address - Country:US
Practice Address - Phone:804-628-6990
Practice Address - Fax:804-628-6969
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166045367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA250009545OtherRAILROAD MEDICARE
VA010068479Medicaid
VAP00479179OtherRAILROAD MEDICARE
VA004407M42Medicare PIN
VA250009545OtherRAILROAD MEDICARE
VAC03684Medicare PIN