Provider Demographics
NPI:1912973223
Name:BAGDASIAN, BRYAN J (MD)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:J
Last Name:BAGDASIAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 WASHINGTON ST STE 2100
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-2470
Mailing Address - Country:US
Mailing Address - Phone:508-690-5122
Mailing Address - Fax:508-286-7273
Practice Address - Street 1:72 WASHINGTON ST STE 2100
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-2470
Practice Address - Country:US
Practice Address - Phone:508-690-5122
Practice Address - Fax:508-286-7273
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTPME6615207R00000X
SC92674207R00000X
MA80872207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA516190Medicaid
MA516190Medicaid
F72236Medicare UPIN