Provider Demographics
NPI:1912961582
Name:BAGHERIAN, SHARAREH (DO)
Entity type:Individual
Prefix:DR
First Name:SHARAREH
Middle Name:
Last Name:BAGHERIAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:135 NEWTON SPARTA RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-2795
Mailing Address - Country:US
Mailing Address - Phone:973-383-8550
Mailing Address - Fax:973-383-8034
Practice Address - Street 1:135 NEWTON SPARTA RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-2795
Practice Address - Country:US
Practice Address - Phone:973-383-8550
Practice Address - Fax:973-383-8034
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221068-1207V00000X
NY2210681207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02158712Medicaid
H40811Medicare UPIN
NY02158712Medicaid