Provider Demographics
NPI:1871672485
Name:BAGLEY, CATHY LORRAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:CATHY
Middle Name:LORRAINE
Last Name:BAGLEY
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:330 ROBERT SMALLS PKWY
Mailing Address - Street 2:SUITE 24-344
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29906-4237
Mailing Address - Country:US
Mailing Address - Phone:843-606-6776
Mailing Address - Fax:
Practice Address - Street 1:330 ROBERT SMALLS PKWY STE 24-344
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29906
Practice Address - Country:US
Practice Address - Phone:843-606-6776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30446207V00000X, 2083P0901X, 2083P0901X
CT459632083P0901X, 2083P0901X
KY479072083P0901X, 2083P0901X
WY10118A2083P0901X, 2083P0901X
NC2015-010362083P0901X, 2083P0901X
GA0386782083P0901X, 2083P0901X
MN593182083P0901X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000627239OMedicaid