Individual
CHARLES H BAGLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
21814 NORTHERN BLVD, 101, BAYSIDE, NY 11361-3581
(718) 229-4868
Mailing address
21814 NORTHERN BLVD, 101, BAYSIDE, NY 11361-3581
(718) 229-4868
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
132024
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01015892
—
NY
01
—
132024
NYS LICENSE
NY
Enumeration date
07/10/2006
Last updated
05/01/2012
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