Provider Demographics
NPI:1639130644
Name:BAGEAC, ALEXANDRU C (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDRU
Middle Name:C
Last Name:BAGEAC
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 1:816 W CANNON ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3146
Mailing Address - Country:US
Mailing Address - Phone:817-321-0937
Mailing Address - Fax:469-522-6889
Practice Address - Street 1:815 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2224
Practice Address - Country:US
Practice Address - Phone:817-321-0300
Practice Address - Fax:817-321-0399
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD258282085R0202X
WAMD600268892085R0202X
TXR39982085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8943547Medicare PIN
WAG8943546Medicare PIN
ORR134943Medicare PIN
ORR132527Medicare PIN
WAG8943549Medicare PIN
ORI41625Medicare UPIN
WAG8943545Medicare PIN
ORR134943Medicare PIN
ORI41625Medicare UPIN
WAG8943545Medicare PIN