Provider Demographics
NPI:1497868442
Name:BAGOUS, TRINE N (MD)
Entity Type:Individual
Prefix:
First Name:TRINE
Middle Name:N
Last Name:BAGOUS
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 1:1330 AMHERST ST STE A
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-3000
Mailing Address - Country:US
Mailing Address - Phone:540-662-0711
Mailing Address - Fax:540-722-3269
Practice Address - Street 1:1330 AMHERST ST STE A
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3000
Practice Address - Country:US
Practice Address - Phone:540-662-0711
Practice Address - Fax:540-722-3269
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235141207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
003248W51Medicare ID - Type Unspecified
I09442Medicare UPIN