Provider Demographics
NPI:1154156370
Name:LEREW, BRYCE
Entity type:Individual
Prefix:MR
First Name:BRYCE
Middle Name:
Last Name:LEREW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3656 CHELTENHAM RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-4250
Mailing Address - Country:US
Mailing Address - Phone:717-799-6373
Mailing Address - Fax:
Practice Address - Street 1:2265 KRAFT DR
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-6360
Practice Address - Country:US
Practice Address - Phone:717-799-6373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program