Healthcare Provider Details

I. General information

NPI: 1962730820
Provider Name (Legal Business Name): BRIAN ALAN PRYOR D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2009
Last Update Date: 06/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4170 CITY AVE
PHILADELPHIA PA
19131-1610
US

IV. Provider business mailing address

300 STAFFORD STREET SUITE 256
SPRINGFIELD MA
01104-3513
US

V. Phone/Fax

Practice location:
  • Phone: 215-871-6100
  • Fax:
Mailing address:
  • Phone: 413-737-2981
  • Fax: 413-748-7416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberOT013221
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number264815
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: