Provider Demographics
NPI:1649561564
Name:BAGLIO, TIM (LEAMP)
Entity Type:Individual
Prefix:MR
First Name:TIM
Middle Name:
Last Name:BAGLIO
Suffix:
Gender:M
Credentials:LEAMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 ELM ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-2745
Mailing Address - Country:US
Mailing Address - Phone:360-224-5427
Mailing Address - Fax:
Practice Address - Street 1:2500 ELM ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-2745
Practice Address - Country:US
Practice Address - Phone:360-224-5427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-26
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60055447171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist