MEDICARE: BRYAN MCDONALD M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	0101240603	VA

General Provider Information

NPI Number	:	1215098322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYAN MCDONALD M.D.

Provider Business Mailing Address
First Line	:	1856 COLONIAL MEDICAL CT
Second Line	:	SUITE D
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-3075
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1856 COLONIAL MEDICAL CT
Second Line	:	SUITE D
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-3075
Country	:	US
Telephone Number	:	757-806-8880
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	01/26/2011

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