Provider Demographics
NPI:1972060986
Name:WRIGHT, BRIAN ALLAN (LAC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:ALLAN
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 148
Mailing Address - Street 2:
Mailing Address - City:NELLYSFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22958-0148
Mailing Address - Country:US
Mailing Address - Phone:434-826-1733
Mailing Address - Fax:
Practice Address - Street 1:900 RITCHIE HWY STE 203
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-4195
Practice Address - Country:US
Practice Address - Phone:434-826-1733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02610171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist