Provider Demographics
NPI:1417932641
Name:BAGGESEN, JOHN RAND (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RAND
Last Name:BAGGESEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7101 JAHNKE RD
Mailing Address - Street 2:SUITE 550-A
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4017
Mailing Address - Country:US
Mailing Address - Phone:804-560-3295
Mailing Address - Fax:888-526-2112
Practice Address - Street 1:7101 JAHNKE RD
Practice Address - Street 2:SUITE 550-A
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-4017
Practice Address - Country:US
Practice Address - Phone:804-560-3295
Practice Address - Fax:888-526-2112
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101057853207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1417932641Medicaid
VA1417932641Medicaid
VA007253V81Medicare PIN
VA020756P84Medicare PIN
VAG79585Medicare UPIN