Provider Demographics
NPI:1588548101
Name:SMALL, BRYAN ANTHONY (CSFA)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:ANTHONY
Last Name:SMALL
Suffix:
Gender:M
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4358 BROAD STREET ROAD
Mailing Address - Street 2:
Mailing Address - City:GUM SPRING
Mailing Address - State:VA
Mailing Address - Zip Code:23065
Mailing Address - Country:US
Mailing Address - Phone:540-223-3922
Mailing Address - Fax:
Practice Address - Street 1:4358 BROAD STREET ROAD
Practice Address - Street 2:
Practice Address - City:GUM SPRING
Practice Address - State:VA
Practice Address - Zip Code:23065
Practice Address - Country:US
Practice Address - Phone:540-223-3922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0137001523246ZS0410X
VA0136000162246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist