Healthcare Provider Details

I. General information

NPI: 1235388679
Provider Name (Legal Business Name): JUANITA SONYA BRYANT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2008
Last Update Date: 04/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 PENNSYLVANIA AVE SE
WASHINGTON DC
20003-4346
US

IV. Provider business mailing address

7501 GREENWAY CENTER DR #300
GREENBELT MD
20770-3514
US

V. Phone/Fax

Practice location:
  • Phone: 202-331-1188
  • Fax: 202-833-8872
Mailing address:
  • Phone: 301-474-4679
  • Fax: 301-474-7182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA103452
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD040362
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberD073928
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number0101251552
License Number StateVA
# 5
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberMD040362
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: