Healthcare Provider Details

I. General information

NPI: 1396778619
Provider Name (Legal Business Name): LEE A BAGGOTT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 12/24/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BURKE LAKEFRONT AIRPORT 1501 N MARGINAL RD. SUITE 162
CLEVELAND OH
44114
US

IV. Provider business mailing address

PO BOX 83
GATES MILLS OH
44040
US

V. Phone/Fax

Practice location:
  • Phone: 216-333-7051
  • Fax:
Mailing address:
  • Phone: 216-333-7051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD12941
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD12941
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.099043
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number35.099043
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number35.099043
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD12941
License Number StateME
# 7
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number35.099043
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: