Healthcare Provider Details

I. General information

NPI: 1871672485
Provider Name (Legal Business Name): CATHY LORRAINE BAGLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 11/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 ROBERT SMALLS PKWY STE 24-344
BEAUFORT SC
29906
US

IV. Provider business mailing address

330 ROBERT SMALLS PKWY SUITE 24-344
BEAUFORT SC
29906-4237
US

V. Phone/Fax

Practice location:
  • Phone: 843-606-6776
  • Fax:
Mailing address:
  • Phone: 843-606-6776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number30446
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number45963
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number47907
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number10118A
License Number StateWY
# 5
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number2015-01036
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number038678
License Number StateGA
# 7
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number59318
License Number StateMN
# 8
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number30446
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: