Provider Demographics
NPI:1588942155
Name:BAGARES, FREDERICK (DO)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:
Last Name:BAGARES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2085 LYNNHAVEN PKWY STE 106
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BCH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-1497
Mailing Address - Country:US
Mailing Address - Phone:757-828-3080
Mailing Address - Fax:757-828-3083
Practice Address - Street 1:4176 S PLAZA TRL STE 218
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1920
Practice Address - Country:US
Practice Address - Phone:757-828-3080
Practice Address - Fax:757-828-3083
Is Sole Proprietor?:No
Enumeration Date:2011-07-29
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01022044412081S0010X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1588942155OtherANTHEM BC/BS
NC1588942155Medicaid
VA1588942155OtherVIRGINIA HEALTH NETWORK
VA1588942155OtherTRICARE/CHAMPUS
VA1588942155OtherOPTIMA HEALTH
VA1588942155OtherAETNA
VA1588942155OtherUNITED HEALTHCARE
VA1588942155OtherCORVEL
VA1588942155Medicaid
VA1588942155OtherCOVENTRY
VA1588942155OtherMULTIPLAN
VA1588942155OtherVIRGINIA PREMIER HEALTH PLAN
VA1588942155OtherUSA MANAGED CARE
VA1588942155OtherCIGNA
VA1588942155OtherANTHEM BC/BS