Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 0101028756 | VA |
NPI | 1265423735 |
---|---|
Provider Name | Mr. Charles E Bagwell |
First Address | Richmond, VA 23225-4017 |
Second Address | Richmond, VA 23225-4017 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2005 |
Last Update Date | 28/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010043891 | (05) | VA |
D19411 | (02) | VA |