Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 7401 | NE |
Y | 207YS0123X | Facial Plastic Surgeon | D0091646 | MD |
NPI | 1710366018 |
---|---|
Provider Name | Dr. Brandon M Wachal |
First Address | Annapolis, MD 21401-1082 |
Second Address | Annapolis, MD 21401-1082 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2015 |
Last Update Date | 21/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1P9933 | MEDICARE (01) | MD |
7401 | TEP NUMBER (01) | NE |
D0091646 | MARYLAND LICENSE (01) | MD |