Provider Demographics
NPI:1194794362
Name:BAGLEY, JOHN J JR (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:BAGLEY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11768
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-0168
Mailing Address - Country:US
Mailing Address - Phone:804-353-4000
Mailing Address - Fax:804-213-9783
Practice Address - Street 1:7660 E PARHAM RD
Practice Address - Street 2:SUITE 208
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-4378
Practice Address - Country:US
Practice Address - Phone:804-527-5866
Practice Address - Fax:804-527-5869
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101018534207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B09051Medicare UPIN