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General NPI Number Information
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NPI Number | 1538623673
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Entity Type | Individual
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Provider Name | BRYAN MICHAEL HAGGARD
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Gender | Male
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Dates
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Enumeration Date | 01/23/2019
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Last Update Date | 08/07/2024
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Provider Practice Location Address
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Address Line | 4414 BENNING RD NE
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City | WASHINGTON
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State | DC
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Zip | 20019-4555
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Country | US
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Telephone | 202-469-4699
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 NEW JERSEY AVE SE STE 500
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City | WASHINGTON
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State | DC
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Zip | 20003-3326
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Country | US
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Telephone | 202-715-7900
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.022905
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License Number State |
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