Healthcare Provider Details

I. General information

NPI: 1184692733
Provider Name (Legal Business Name): HUGH MCLELLAN BRYAN III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 09/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7584 HOSPITAL DR BUILDING C, SUITE 202
GLOUCESTER VA
23061-4178
US

IV. Provider business mailing address

856 J CLYDE MORRIS BLVD SUITE A
NEWPORT NEWS VA
23601-1318
US

V. Phone/Fax

Practice location:
  • Phone: 804-693-4645
  • Fax: 804-693-5985
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0101042323
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: