Individual
SEYOUM DAFFO BAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
800 GRAND CENTRAL MALL STE 10, VIENNA, WV 26105-4100
(304) 916-1288
(304) 916-1289
Mailing address
800 GRAND CENTRAL MALL STE 10, VIENNA, WV 26105-4100
(304) 916-1288
(304) 916-1289
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
21587
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2502232
—
OH
05
—
3810000748
—
WV
Enumeration date
02/28/2006
Last updated
10/09/2013
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