Provider Demographics
NPI:1114997301
Name:BAGAL, AMITA (MD)
Entity Type:Individual
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First Name:AMITA
Middle Name:
Last Name:BAGAL
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Gender:F
Credentials:MD
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Mailing Address - Street 1:1447 YORK RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6022
Mailing Address - Country:US
Mailing Address - Phone:410-252-9090
Mailing Address - Fax:410-252-9090
Practice Address - Street 1:1447 YORK RD
Practice Address - Street 2:SUITE 301
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6017
Practice Address - Country:US
Practice Address - Phone:410-252-9090
Practice Address - Fax:443-378-8887
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2011-11-23
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Provider Licenses
StateLicense IDTaxonomies
MDD00716272082S0099X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
H70027Medicare UPIN