Healthcare Provider Details

I. General information

NPI: 1306753124
Provider Name (Legal Business Name): BRENDAN BAGNALL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11890 HEALING WAY
SILVER SPRING MD
20904-7917
US

IV. Provider business mailing address

1220 TIMBER RIDGE DR
SILVER SPRING MD
20905-3920
US

V. Phone/Fax

Practice location:
  • Phone: 301-315-3030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR232659
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: