Basic Information
| Provider Information | |||||||||
| NPI: | 1053376483 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAGHERITOOLABI | ||||||||
| FirstName: | MARYAM | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 423 E 23RD ST | ||||||||
| Address2: | DEPARTMENT OF ANESTHESIOLOGY, 4TH FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100105011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2126867500 | ||||||||
| FaxNumber: | 2129513425 | ||||||||
| Practice Location | |||||||||
| Address1: | 555 W 23RD ST | ||||||||
| Address2: | S12B | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100111011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6468315063 | ||||||||
| FaxNumber: | 2129513425 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2006 | ||||||||
| LastUpdateDate: | 02/26/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 4301084798 | MI | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.