Healthcare Provider Details

I. General information

NPI: 1104842061
Provider Name (Legal Business Name): SOLOMON DAFFO BAGAE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 08/04/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MATTHEW ST STE 302
MARIETTA OH
45750-1656
US

IV. Provider business mailing address

416 COLEGATE DR BLDG 3
MARIETTA OH
45750-9549
US

V. Phone/Fax

Practice location:
  • Phone: 740-568-5207
  • Fax: 740-568-5297
Mailing address:
  • Phone: 740-568-4814
  • Fax: 740-374-3165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35.128475
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number001293
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: