Provider Demographics
NPI:1265545438
Name:DAGHLIAN, BEDROS D (MD)
Entity type:Individual
Prefix:
First Name:BEDROS
Middle Name:D
Last Name:DAGHLIAN
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:PO BOX 11225
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37401-2225
Mailing Address - Country:US
Mailing Address - Phone:423-892-9483
Mailing Address - Fax:423-899-0928
Practice Address - Street 1:975 E 3RD ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2103
Practice Address - Country:US
Practice Address - Phone:423-778-7608
Practice Address - Fax:423-778-2360
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD11456207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN050060797OtherMEDICARE RAILROAD
TN3074809OtherBLUE CROSS BLUE SHIELD OF TN
AL009801390Medicaid
NC890525KMedicaid
TN3182340Medicaid
GA000314883BMedicaid
TN3182340Medicaid
B04018Medicare UPIN
TN3182340Medicaid