Provider Demographics
NPI:1396778619
Name:BAGGOTT, LEE A (MD)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:A
Last Name:BAGGOTT
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:PO BOX 83
Mailing Address - Street 2:
Mailing Address - City:GATES MILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44040
Mailing Address - Country:US
Mailing Address - Phone:216-333-7051
Mailing Address - Fax:
Practice Address - Street 1:BURKE LAKEFRONT AIRPORT
Practice Address - Street 2:1501 N MARGINAL RD. SUITE 162
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114
Practice Address - Country:US
Practice Address - Phone:216-333-7051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD12941207R00000X, 207RC0200X, 207RP1001X, 207RC0200X, 207RP1001X
OH35.099043207R00000X, 207RC0200X, 207RP1001X, 2083A0100X, 207RP1001X, 207RC0200X, 207RC0200X
NY163926207RP1001X
CAG148524207RP1001X
VA0101262700207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Yes2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME046076OtherANTHEM BLUE CROSS BLUE SHIELD
MEM59001OtherCIGNA
ME5757272OtherAETNA
OH000000851675OtherANTHEM BLUE CROSS BLUE SHIELD
OH0094506Medicaid
ME189790000Medicaid
OHP01772689OtherRAILROAD MEDICARE
MEP00024541OtherRAILROAD MEDICARE
ME046076OtherANTHEM BLUE CROSS BLUE SHIELD