MEDICARE: DR. BRYAN ALLEN EHLERT MD

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	2086S0129X	Vascular Surgery Physician	2016-00589	NC
2	208600000X	Surgery Physician	2016-00589	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	19J65	OTHER	NC	BCBSNC

General Provider Information

NPI Number	:	1225296999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRYAN ALLEN EHLERT MD

Provider Business Mailing Address
First Line	:	2000 PERIMETER PARK DR STE 200
Second Line	:
City	:	MORRISVILLE
State	:	NC
Zip	:	27560-8442
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	208 COX BLVD STE 201
Second Line	:
City	:	GOLDSBORO
State	:	NC
Zip	:	27534-9414
Country	:	US
Telephone Number	:	919-587-3333
Fax Number	:	919-587-3334

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

Provider Enumeration Date	:	05/29/2008
Last Update Date	:	12/29/2023

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