Provider Demographics
NPI:1306959739
Name:VANGRAAFEILAND, BRIGIT B (CRNP)
Entity type:Individual
Prefix:
First Name:BRIGIT
Middle Name:B
Last Name:VANGRAAFEILAND
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 DOEFIELD CT
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-3066
Mailing Address - Country:US
Mailing Address - Phone:443-512-0609
Mailing Address - Fax:
Practice Address - Street 1:105 PENN ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1020
Practice Address - Country:US
Practice Address - Phone:410-706-5181
Practice Address - Fax:410-706-5103
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR145405208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD148808200Medicaid