Provider Demographics
NPI:1124040522
Name:KORNREICH, BRYAN ASHER (MD)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:ASHER
Last Name:KORNREICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 AMHERST ST
Mailing Address - Street 2:BLDG C
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-3323
Mailing Address - Country:US
Mailing Address - Phone:540-662-3853
Mailing Address - Fax:540-662-0336
Practice Address - Street 1:1002 AMHERST ST
Practice Address - Street 2:BLDG C
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3323
Practice Address - Country:US
Practice Address - Phone:540-662-3853
Practice Address - Fax:540-662-0336
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057125208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA284240OtherANTHEM
WV0212025000Medicaid
VA284240OtherANTHEM