Provider Demographics
NPI:1225149107
Name:BAGGETT, MERIDALE V (MD)
Entity Type:Individual
Prefix:
First Name:MERIDALE
Middle Name:V
Last Name:BAGGETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 STANIFORD ST
Mailing Address - Street 2:SUITE 503B
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2517
Mailing Address - Country:US
Mailing Address - Phone:617-643-0594
Mailing Address - Fax:617-643-0660
Practice Address - Street 1:50 STANIFORD ST
Practice Address - Street 2:SUITE 503B
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2517
Practice Address - Country:US
Practice Address - Phone:617-643-0594
Practice Address - Fax:617-643-0660
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAML20007997207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine