Provider Demographics
NPI:1851618920
Name:M TAREK BAGHDADI MD
Entity Type:Organization
Organization Name:M TAREK BAGHDADI MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:L
Authorized Official - Last Name:PILKENTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-383-5628
Mailing Address - Street 1:1802 YAKIMA AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4499
Mailing Address - Country:US
Mailing Address - Phone:253-383-5628
Mailing Address - Fax:253-383-5687
Practice Address - Street 1:1802 YAKIMA AVE
Practice Address - Street 2:STE 300
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4499
Practice Address - Country:US
Practice Address - Phone:253-383-5628
Practice Address - Fax:253-383-5687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-28
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00026186174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1055185Medicaid
WA1055185Medicaid