Provider Demographics
NPI:1760752349
Name:BAGSHAW, ROGER JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:JAMES
Last Name:BAGSHAW
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 1:18 SPRINGHOUSE LN
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-2464
Mailing Address - Country:US
Mailing Address - Phone:215-591-2359
Mailing Address - Fax:
Practice Address - Street 1:18 SPRINGHOUSE LN
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-2464
Practice Address - Country:US
Practice Address - Phone:215-591-2359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030465L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology