Provider Demographics
NPI:1154385912
Name:BRYANT, TAMIKO A (MD)
Entity type:Individual
Prefix:DR
First Name:TAMIKO
Middle Name:A
Last Name:BRYANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17001 SCIENCE DR
Mailing Address - Street 2:#118
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-4329
Mailing Address - Country:US
Mailing Address - Phone:240-245-3484
Mailing Address - Fax:240-245-3486
Practice Address - Street 1:17001 SCIENCE DR
Practice Address - Street 2:#118
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-4329
Practice Address - Country:US
Practice Address - Phone:240-245-3484
Practice Address - Fax:240-245-3486
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0054820207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD64629707OtherBCBS
DCK6430004OtherBCBS
MD003388000Medicaid
MD64629707OtherBCBS
MDH00347Medicare UPIN
MD003388000Medicaid
MD796MMedicare PIN