Provider Demographics
NPI:1902888944
Name:LORCH, BRYAN DANIEL (PA)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:DANIEL
Last Name:LORCH
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2514 WESLEY ST
Mailing Address - Street 2:102
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-1764
Mailing Address - Country:US
Mailing Address - Phone:423-282-8070
Mailing Address - Fax:423-282-8550
Practice Address - Street 1:2514 WESLEY ST
Practice Address - Street 2:102
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-1764
Practice Address - Country:US
Practice Address - Phone:423-282-8070
Practice Address - Fax:423-282-8550
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA0000000982363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP77132Medicare UPIN
TN3689549Medicare ID - Type Unspecified