Provider Demographics
NPI:1982067971
Name:BRYANT CONNAH, MARTHE MELANIE (MD)
Entity type:Individual
Prefix:
First Name:MARTHE
Middle Name:MELANIE
Last Name:BRYANT CONNAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARTHE
Other - Middle Name:MELANIE
Other - Last Name:BRYANT-GENEVIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:82 CATAMOUNT PARK
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-1292
Practice Address - Country:US
Practice Address - Phone:802-388-7185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-29
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC82991207Q00000X
VT042-0015779207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC829919Medicaid