Provider Demographics
NPI:1619904331
Name:BRYER, JOSEPH BAUGHER (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:BAUGHER
Last Name:BRYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1228 WHITE WOOD WAY
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-7063
Mailing Address - Country:US
Mailing Address - Phone:610-388-9663
Mailing Address - Fax:302-426-9440
Practice Address - Street 1:2300 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 3B
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-1392
Practice Address - Country:US
Practice Address - Phone:302-426-9440
Practice Address - Fax:302-426-0329
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC100035472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEC10003547OtherSTATE MEDICAL LICENSE
DE0000244901Medicaid
DE0000244901Medicaid