Healthcare Provider Details

I. General information

NPI: 1003417817
Provider Name (Legal Business Name): BRYANT HEALTH CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2020
Last Update Date: 01/20/2021
Certification Date: 01/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7288 EVANS MILL RD
MC LEAN VA
22101-3424
US

IV. Provider business mailing address

PO BOX 1758
NEW YORK NY
10021-0047
US

V. Phone/Fax

Practice location:
  • Phone: 703-828-7623
  • Fax: 604-259-2877
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTOPHER L CHANG
Title or Position: CO- FOUNDER/CEO
Credential: MD
Phone: 703-828-7623