Provider Demographics
NPI:1811791486
Name:BAGNEKI, CASIMIR
Entity type:Individual
Prefix:MR
First Name:CASIMIR
Middle Name:
Last Name:BAGNEKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 SIR MICHAEL PL
Mailing Address - Street 2:
Mailing Address - City:GLENARDEN
Mailing Address - State:MD
Mailing Address - Zip Code:20706-1687
Mailing Address - Country:US
Mailing Address - Phone:240-478-0608
Mailing Address - Fax:
Practice Address - Street 1:2705 SIR MICHAEL PL
Practice Address - Street 2:
Practice Address - City:GLENARDEN
Practice Address - State:MD
Practice Address - Zip Code:20706-1687
Practice Address - Country:US
Practice Address - Phone:240-478-0608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator