MEDICARE: BRIANNA LYNN BAGDASIAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1962366765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIANNA LYNN BAGDASIAN

Provider Business Mailing Address
First Line	:	725 COLEMAN BLVD APT 409
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-6008
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	725 COLEMAN BLVD APT 409
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-6008
Country	:	US
Telephone Number	:	508-386-7763
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2025
Last Update Date	:	12/15/2025

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