Provider Demographics
NPI:1497733943
Name:BAGHERI, ABBASS (MD)
Entity Type:Individual
Prefix:
First Name:ABBASS
Middle Name:
Last Name:BAGHERI
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 1:275 GRAHAM RD
Mailing Address - Street 2:STE 6
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223
Mailing Address - Country:US
Mailing Address - Phone:330-923-9962
Mailing Address - Fax:330-923-9404
Practice Address - Street 1:275 GRAHAM RD
Practice Address - Street 2:STE 6
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223
Practice Address - Country:US
Practice Address - Phone:330-923-9962
Practice Address - Fax:330-923-9404
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH32254207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0201356Medicaid
OHBA0152124Medicare ID - Type Unspecified
OH0201356Medicaid