MEDICARE: DR. BORIS BAGDASARIAN 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	207RH0003X	Hematology & Oncology Physician	20A6598	CA

General Provider Information

NPI Number	:	1598758062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BORIS BAGDASARIAN D.O.

Provider Business Mailing Address
First Line	:	541 W COLORADO ST STE 205
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91204-3640
Country	:	US
Telephone Number	:	323-254-0046
Fax Number	:	323-488-9782

Provider Business Practice Location Address
First Line	:	1505 WILSON TER
Second Line	:	SUITE 200
City	:	GLENDALE
State	:	CA
Zip	:	91206-4071
Country	:	US
Telephone Number	:	818-409-0105
Fax Number	:	818-409-0151

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

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	03/13/2020

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