Healthcare Provider Details

I. General information

NPI: 1124040522
Provider Name (Legal Business Name): BRYAN ASHER KORNREICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 AMHERST ST BLDG C
WINCHESTER VA
22601-3323
US

IV. Provider business mailing address

1002 AMHERST ST BLDG C
WINCHESTER VA
22601-3323
US

V. Phone/Fax

Practice location:
  • Phone: 540-662-3853
  • Fax: 540-662-0336
Mailing address:
  • Phone: 540-662-3853
  • Fax: 540-662-0336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101057125
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: