Provider Demographics
NPI:1952745713
Name:LOCKMER, BRYAN W (DO)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:W
Last Name:LOCKMER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 GROVE ROAD
Mailing Address - Street 2:SUITE M123
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15236
Mailing Address - Country:US
Mailing Address - Phone:412-881-2255
Mailing Address - Fax:412-881-5335
Practice Address - Street 1:5301 GROVE RD STE M123
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15236-5602
Practice Address - Country:US
Practice Address - Phone:412-881-2255
Practice Address - Fax:412-881-5335
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAOS0186382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program