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General NPI Number Information
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NPI Number | 1659445781
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Entity Type | Individual
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Provider Name | GRANT P BAGLEY MD
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Gender | Male
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 555 TWELFTH ST NW
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City | WASHINGTON
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State | DC
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Zip | 20004
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Country | US
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Telephone | 202-942-5928
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Fax |
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Provider Business Mailing Address
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Address Line | 1101 FRANCIS AVE
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City | BALTIMORE
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State | MD
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Zip | 21227
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Country | US
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Telephone | 410-242-9216
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MD3984
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License Number State | DC
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