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General NPI Number Information
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NPI Number | 1588942155
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Entity Type | Individual
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Provider Name | FREDERICK BAGARES D.O.
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Gender | Male
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Dates
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Enumeration Date | 07/29/2011
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 4176 S PLAZA TRL STE 218
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-1920
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Country | US
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Telephone | 757-828-3080
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Fax | 757-828-3083
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Provider Business Mailing Address
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Address Line | 2085 LYNNHAVEN PKWY STE 106
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City | VIRGINIA BCH
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State | VA
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Zip | 23456-1497
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Country | US
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Telephone | 757-828-3080
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Fax | 757-828-3083
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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 | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 0102204441
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 0102204441
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License Number State | VA
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