Provider Demographics
NPI:1790012607
Name:DR. H C BAGGETT, PA
Entity Type:Organization
Organization Name:DR. H C BAGGETT, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:CLIFFORD
Authorized Official - Last Name:BAGGETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-782-0890
Mailing Address - Street 1:2518 WAKE DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27608-1340
Mailing Address - Country:US
Mailing Address - Phone:919-782-0890
Mailing Address - Fax:919-882-9707
Practice Address - Street 1:2518 WAKE DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27608-1340
Practice Address - Country:US
Practice Address - Phone:919-782-0890
Practice Address - Fax:919-882-9707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-13
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16821207YS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0012XAllopathic & Osteopathic PhysiciansOtolaryngologySleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8912467Medicaid
NC8912467Medicaid