Basic Information
| Provider Information | |||||||||
| NPI: | 1285838482 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAGLEY | ||||||||
| FirstName: | REBECCA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5001 ROCKSIDE ROAD, IN 20 | ||||||||
| Address2: | CLEVELAND CLINIC FHC, INDEPENDENCE | ||||||||
| City: | INDEPENDENCE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2169864000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5001 ROCKSIDE RD # IN20 | ||||||||
| Address2: | |||||||||
| City: | INDEPENDENCE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441312172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2169864000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2007 | ||||||||
| LastUpdateDate: | 01/14/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 57012475 | OH | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 3092139 | 05 | OH | MEDICAID |