Individual
DR. SHOLEH BAGHERI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1615 DELAWARE ST, LONGVIEW, WA 98632-2310
(360) 414-2730
(360) 414-2739
Mailing address
PO BOX 3002, LONGVIEW, WA 98632-0302
(360) 414-2048
(360) 575-6749
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
216509
NY
207R00000X
Internal Medicine Physician
MD00047589
WA
207RP1001X
Pulmonary Disease Physician
Primary
MD00047589
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0219444
LABOR & INDUSTRIES
WA
05
—
02529362
—
NY
05
—
8477382
—
WA
01
—
8944123
CRIME VICTIMS
WA
01
—
P00392543
RAILROAD MEDICARE
—
Enumeration date
08/31/2006
Last updated
02/05/2008
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