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Individual

DR. BRANDON M WACHAL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
600 RIDGELY AVE STE 110, ANNAPOLIS, MD 21401-1082
(410) 573-9191
(410) 573-5910
Mailing address
600 RIDGELY AVE STE 110, ANNAPOLIS, MD 21401-1082
(410) 573-9191
(410) 573-5910

Taxonomy

Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
7401
NE
207Y00000X
Otolaryngology Physician
D0091646
MD
207YS0123X
Facial Plastic Surgery Physician
Primary
D0091646
MD
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
D0091646
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
219423600
MD
01
4695852
AETNA
MD
01
7401
TEP NUMBER
NE
01
D0091646
MARYLAND LICENSE
MD
01
FN66-0003
CAREFIRST BCBS
MD
Enumeration date
05/20/2015
Last updated
10/10/2022
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