Provider Demographics
NPI:1306393129
Name:BAGALMAN, PAUL MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:MICHAEL
Last Name:BAGALMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:PAUL
Other - Middle Name:M
Other - Last Name:BAGALMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3004 METAIRIE CT
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-5014
Mailing Address - Country:US
Mailing Address - Phone:504-832-7246
Mailing Address - Fax:
Practice Address - Street 1:3004 METAIRIE CT
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-5014
Practice Address - Country:US
Practice Address - Phone:504-832-7246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.008945261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAMD.008945OtherMEDICAL LICENSE