Provider Demographics
NPI:1306614136
Name:BAGIRANEZA, WILLIBRORD
Entity type:Individual
Prefix:
First Name:WILLIBRORD
Middle Name:
Last Name:BAGIRANEZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4309 MARIGOLD LN
Mailing Address - Street 2:
Mailing Address - City:BELCAMP
Mailing Address - State:MD
Mailing Address - Zip Code:21017-1668
Mailing Address - Country:US
Mailing Address - Phone:484-683-5733
Mailing Address - Fax:
Practice Address - Street 1:2118 GREENSPRING DR
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-3112
Practice Address - Country:US
Practice Address - Phone:410-560-7514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist