Healthcare Provider Details

I. General information

NPI: 1831414374
Provider Name (Legal Business Name): SHAHINE BAGHAI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2010
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 S HANOVER ST DEPT OF RADIOLOGY
BALTIMORE MD
21225-1233
US

IV. Provider business mailing address

4061 POWDER MILL RD SUITE 210
CALVERTON MD
20705-3149
US

V. Phone/Fax

Practice location:
  • Phone: 410-350-3300
  • Fax: 410-350-2033
Mailing address:
  • Phone: 301-325-8515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberD74905
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberD74905
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: