MEDICARE: DR. SANDEEP BAGLA M.D.

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	2085R0204X	Vascular & Interventional Radiology Physician	0101241063	VA
2	2085R0202X	Diagnostic Radiology Physician	0101241063	VA
3	2085R0204X	Vascular & Interventional Radiology Physician	ME167210	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689718611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDEEP BAGLA M.D.

Provider Business Mailing Address
First Line	:	2296 OPITZ BLVD STE 350
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22191
Country	:	US
Telephone Number	:	703-783-5353
Fax Number	:	703-348-7677

Provider Business Practice Location Address
First Line	:	2755 HARTLAND RD STE 110
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22043-3544
Country	:	US
Telephone Number	:	703-783-5353
Fax Number	:

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

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	02/07/2026

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Directions to “ DR. SANDEEP BAGLA M.D.” Practice Location

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