MEDICARE: FREDERICK BAGARES D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician	0102204441	VA
2	208100000X	Physical Medicine & Rehabilitation Physician	0102204441	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1588942155	OTHER	VA	ANTHEM BC/BS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1588942155	OTHER	VA	VIRGINIA HEALTH NETWORK
4	1588942155	OTHER	VA	TRICARE/CHAMPUS
5	1588942155	OTHER	VA	OPTIMA HEALTH
6	1588942155	OTHER	VA	AETNA
7	1588942155	OTHER	VA	UNITED HEALTHCARE
8	1588942155	OTHER	VA	CORVEL
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	1588942155	OTHER	VA	COVENTRY
11	1588942155	OTHER	VA	MULTIPLAN
12	1588942155	OTHER	VA	VIRGINIA PREMIER HEALTH PLAN
13	1588942155	OTHER	VA	USA MANAGED CARE
14	1588942155	OTHER	VA	CIGNA

General Provider Information

NPI Number	:	1588942155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FREDERICK BAGARES D.O.

Provider Business Mailing Address
First Line	:	2085 LYNNHAVEN PKWY STE 106
Second Line	:
City	:	VIRGINIA BCH
State	:	VA
Zip	:	23456-1497
Country	:	US
Telephone Number	:	757-828-3080
Fax Number	:	757-828-3083

Provider Business Practice Location Address
First Line	:	4176 S PLAZA TRL STE 218
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-1920
Country	:	US
Telephone Number	:	757-828-3080
Fax Number	:	757-828-3083

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2011
Last Update Date	:	10/21/2024

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Directions to “ FREDERICK BAGARES D.O.” Practice Location

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