Provider Demographics
NPI:1174554398
Name:BRYANT, BRANDON JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:JAMES
Last Name:BRYANT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8100 INNOVATION PARK DR STE 110
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4870
Mailing Address - Country:US
Mailing Address - Phone:571-472-6464
Mailing Address - Fax:571-472-0451
Practice Address - Street 1:8100 INNOVATION PARK DR STE 110
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4870
Practice Address - Country:US
Practice Address - Phone:571-472-6464
Practice Address - Fax:571-472-0451
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80125207X00000X
MDD0082026207XX0005X
DCMD044561207XX0005X
NC2010-01313207XX0005X
VA0101260383207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI51062Medicare UPIN