Individual
FREDERICK BAGARES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
4176 S PLAZA TRL STE 218, VIRGINIA BEACH, VA 23452-1920
(757) 828-3080
(757) 828-3083
Mailing address
2085 LYNNHAVEN PKWY STE 106, VIRGINIA BCH, VA 23456-1497
(757) 828-3080
(757) 828-3083
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
0102204441
VA
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
0102204441
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1588942155
ANTHEM BC/BS
VA
05
—
1588942155
—
NC
05
—
1588942155
—
VA
Enumeration date
07/29/2011
Last updated
10/21/2024
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