Provider Demographics
NPI:1841812351
Name:BAGGA, BARUN (MD)
Entity type:Individual
Prefix:MR
First Name:BARUN
Middle Name:
Last Name:BAGGA
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 1:462 FIRST AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:212-263-6373
Mailing Address - Fax:212-263-7666
Practice Address - Street 1:462 FIRST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:212-263-6373
Practice Address - Fax:212-263-7666
Is Sole Proprietor?:No
Enumeration Date:2020-05-07
Last Update Date:2022-05-05
Deactivation Date:2022-01-11
Deactivation Code:
Reactivation Date:2022-01-25
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY3141362085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program