Provider Demographics
NPI:1164449906
Name:BAGINSKI, PIOTR WALDEMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:PIOTR
Middle Name:WALDEMAR
Last Name:BAGINSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 HICKORY LANE
Mailing Address - Street 2:
Mailing Address - City:ANSONIA
Mailing Address - State:CT
Mailing Address - Zip Code:06403
Mailing Address - Country:US
Mailing Address - Phone:203-732-5834
Mailing Address - Fax:203-735-2614
Practice Address - Street 1:4 CORPORATE DR
Practice Address - Street 2:SUITE 283
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-6211
Practice Address - Country:US
Practice Address - Phone:203-944-9775
Practice Address - Fax:203-944-9964
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT39585207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H41803Medicare UPIN