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General NPI Number Information
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NPI Number | 1780875633
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Entity Type | Organization
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Legal Business Name | CURTIS BRYAN MD LTD
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Dates
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Enumeration Date | 08/06/2007
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Last Update Date | 08/06/2007
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Provider Practice Location Address
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Address Line | 637 KINGSBOROUGH SQ SUITE H
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City | CHESAPEAKE
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State | VA
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Zip | 23320-4944
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Country | US
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Telephone | 757-486-0178
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Fax | 757-410-1487
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Provider Business Mailing Address
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Address Line | 637 KINGSBOROUGH SQ SUITE H
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City | CHESAPEAKE
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State | VA
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Zip | 23320-4944
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Country | US
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Telephone | 757-486-0178
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Fax | 757-410-1487
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. CURTIS RUSSELL BRYAN
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Credential | MD
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Telephone | 757-486-0178
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 0101041906
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License Number State | VA
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