Provider Demographics
NPI:1316151251
Name:REGN, DARA DANIELA (MD)
Entity type:Individual
Prefix:DR
First Name:DARA
Middle Name:DANIELA
Last Name:REGN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DARA
Other - Middle Name:DANIELA
Other - Last Name:BAGWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:88TH MEDICAL GROUP
Mailing Address - Street 2:4881 SUGAR MAPLE DR BLDG 830
Mailing Address - City:WPAFB
Mailing Address - State:OH
Mailing Address - Zip Code:45433-5529
Mailing Address - Country:US
Mailing Address - Phone:937-257-7218
Mailing Address - Fax:937-257-0417
Practice Address - Street 1:88 MEDICAL GROUP
Practice Address - Street 2:4881 SUGAR MAPLE DR
Practice Address - City:WPAFB
Practice Address - State:OH
Practice Address - Zip Code:45433
Practice Address - Country:US
Practice Address - Phone:937-257-7218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101238577207RC0200X, 207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine