Individual
JUDITH TALLANT BAGGETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1760 OLD MEADOW RD STE 500, MC LEAN, VA 22102-4306
(703) 810-5217
Mailing address
1760 OLD MEADOW RD STE 500, MC LEAN, VA 22102-4306
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0024182365
VA
363LF0000X
Family Nurse Practitioner
Primary
0024182365
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1891460549
—
VA
Enumeration date
08/14/2021
Last updated
01/10/2024
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