Provider Demographics
NPI:1699730515
Name:MCKENZIE, BRYAN ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:ANTHONY
Last Name:MCKENZIE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3801 UNIVERSITY DR
Mailing Address - Street 2:# 200
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2503
Mailing Address - Country:US
Mailing Address - Phone:703-573-7600
Mailing Address - Fax:703-560-3808
Practice Address - Street 1:8316 ARLINGTON BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-5207
Practice Address - Country:US
Practice Address - Phone:703-573-7600
Practice Address - Fax:703-560-3808
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101055139207YX0901X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0010OtherCAREFIRST ID#
VA0101055139OtherSTATE LICENSE #
VA006501362Medicaid