Healthcare Provider Details

I. General information

NPI: 1124043823
Provider Name (Legal Business Name): HENRY CLIFFORD BAGGETT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 04/14/2021
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 GLENWOOD GARDENS LN UNIT 308
RALEIGH NC
27608-1399
US

IV. Provider business mailing address

2701 GLENWOOD GARDENS LN UNIT 308
RALEIGH NC
27608-1399
US

V. Phone/Fax

Practice location:
  • Phone: 919-782-0890
  • Fax:
Mailing address:
  • Phone: 919-782-0890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number16821
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207YS0012X
TaxonomySleep Medicine (Otolaryngology) Physician
License Number16821
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: