Provider Demographics
NPI:1720782923
Name:BAGHDOUST, MELODY
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:BAGHDOUST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8801 RUSTBURG CIR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-4936
Mailing Address - Country:US
Mailing Address - Phone:301-820-5950
Mailing Address - Fax:
Practice Address - Street 1:8801 RUSTBURG CIR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY VILLAGE
Practice Address - State:MD
Practice Address - Zip Code:20886-4936
Practice Address - Country:US
Practice Address - Phone:301-820-5950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD236Medicaid