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General NPI Number Information
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NPI Number | 1710366018
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Entity Type | Individual
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Provider Name | BRANDON M WACHAL M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/20/2015
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Last Update Date | 10/10/2022
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Provider Practice Location Address
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Address Line | 600 RIDGELY AVE STE 110
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City | ANNAPOLIS
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State | MD
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Zip | 21401-1082
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Country | US
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Telephone | 410-573-9191
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Fax | 410-573-5910
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Provider Business Mailing Address
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Address Line | 600 RIDGELY AVE STE 110
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City | ANNAPOLIS
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State | MD
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Zip | 21401-1082
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Country | US
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Telephone | 410-573-9191
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Fax | 410-573-5910
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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 | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | D0091646
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 7401
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License Number State | NE
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Taxonomy #3
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Taxonomy Code | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number | D0091646
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License Number State | MD
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Taxonomy #4
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Taxonomy Code | 207YS0123X
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Taxonomy Name | Facial Plastic Surgery Physician
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License Number | D0091646
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License Number State | MD
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