Provider Demographics
NPI:1376650697
Name:BAGHDADI, M. TAREK (MD)
Entity Type:Individual
Prefix:
First Name:M.
Middle Name:TAREK
Last Name:BAGHDADI
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 1:1802 YAKIMA AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4499
Mailing Address - Country:US
Mailing Address - Phone:253-383-5628
Mailing Address - Fax:253-383-5687
Practice Address - Street 1:1802 YAKIMA AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4499
Practice Address - Country:US
Practice Address - Phone:253-383-5628
Practice Address - Fax:253-383-5687
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00026186174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG001001816OtherGROUP PTAN
WAGAB11662OtherINDIVDUAL PTAN
WA1055185Medicaid
WAGAB11662OtherINDIVDUAL PTAN
WA1055185Medicaid