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General NPI Number Information
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NPI Number | 1104842061
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Entity Type | Individual
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Provider Name | SOLOMON DAFFO BAGAE M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 08/04/2023
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Provider Practice Location Address
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Address Line | 400 MATTHEW ST STE 302
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City | MARIETTA
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State | OH
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Zip | 45750-1656
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Country | US
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Telephone | 740-568-5207
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Fax | 740-568-5297
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Provider Business Mailing Address
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Address Line | 416 COLEGATE DR BLDG 3
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City | MARIETTA
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State | OH
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Zip | 45750-9549
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Country | US
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Telephone | 740-568-4814
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Fax | 740-374-3165
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 35.128475
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 001293
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License Number State | NY
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