Provider Demographics
NPI:1932143724
Name:BAGLEY, NANCY ANN (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ANN
Last Name:BAGLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03756-1000
Mailing Address - Country:US
Mailing Address - Phone:603-650-6330
Mailing Address - Fax:603-650-6390
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-1000
Practice Address - Country:US
Practice Address - Phone:603-650-6330
Practice Address - Fax:603-650-6390
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6602208100000X
VT042-0006827208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH00000004Medicaid
VT0005544Medicaid
C65581Medicare UPIN
NH00000004Medicaid
NHVT554403Medicare PIN
VTVT554402Medicare PIN