Provider Demographics
NPI:1114925716
Name:DAGGETT, BRIAN GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:GEORGE
Last Name:DAGGETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:ORLEANS
Mailing Address - State:MA
Mailing Address - Zip Code:02653
Mailing Address - Country:US
Mailing Address - Phone:508-255-8825
Mailing Address - Fax:518-758-2162
Practice Address - Street 1:204 MAIN STREET
Practice Address - Street 2:
Practice Address - City:ORLEANS
Practice Address - State:MA
Practice Address - Zip Code:02653
Practice Address - Country:US
Practice Address - Phone:508-255-8825
Practice Address - Fax:518-758-2162
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146777-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00961344Medicaid
NY00961344Medicaid
NY58N711Medicare ID - Type Unspecified