Provider Demographics
NPI:1619221959
Name:HASLAM, BRIDGET K (PA-C)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:K
Last Name:HASLAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:K
Other - Last Name:MCGRATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 62440
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-2440
Mailing Address - Country:US
Mailing Address - Phone:410-625-5050
Mailing Address - Fax:410-766-1404
Practice Address - Street 1:331 OAK MANOR DR
Practice Address - Street 2:SUITE 201
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5548
Practice Address - Country:US
Practice Address - Phone:410-625-5050
Practice Address - Fax:410-766-1404
Is Sole Proprietor?:No
Enumeration Date:2012-11-08
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0004905363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical