Provider Demographics
NPI:1962884700
Name:BAGHDADI, YASER (MD MSC)
Entity type:Individual
Prefix:
First Name:YASER
Middle Name:
Last Name:BAGHDADI
Suffix:
Gender:M
Credentials:MD MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10112 AVALON GATES
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-5836
Mailing Address - Country:US
Mailing Address - Phone:507-271-8918
Mailing Address - Fax:
Practice Address - Street 1:10112 AVALON GATES
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-5836
Practice Address - Country:US
Practice Address - Phone:507-271-8918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-28
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300801208D00000X
390200000X
CT66998208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program