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General NPI Number Information
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NPI Number | 1407016108
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Entity Type | Individual
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Provider Name | MELISSA BAHAREH BAGLOO MD
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Gender | Female
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Dates
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Enumeration Date | 06/16/2008
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Last Update Date | 04/20/2022
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Provider Practice Location Address
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Address Line | 1925 MIZELL AVE STE 201
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City | WINTER PARK
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State | FL
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Zip | 32792-4155
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Country | US
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Telephone | 407-303-7399
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Fax |
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Provider Business Mailing Address
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Address Line | 1925 MIZELL AVE STE 201
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City | WINTER PARK
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State | FL
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Zip | 32792-4155
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Country | US
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Telephone | 407-303-7399
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Fax |
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 246679-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 25MA08805600
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME146371
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License Number State | FL
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