Provider Demographics
NPI:1548320724
Name:BAGHERIAN, VAHID (MD)
Entity type:Individual
Prefix:DR
First Name:VAHID
Middle Name:
Last Name:BAGHERIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:VAHID
Other - Middle Name:
Other - Last Name:BAGHERIAN KHARRATI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:720 US HWY 259 N.
Mailing Address - Street 2:
Mailing Address - City:ORE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75683-5639
Mailing Address - Country:US
Mailing Address - Phone:903-968-2847
Mailing Address - Fax:903-968-2216
Practice Address - Street 1:720 US HIGHWAY 259 N
Practice Address - Street 2:
Practice Address - City:ORE CITY
Practice Address - State:TX
Practice Address - Zip Code:75683-5763
Practice Address - Country:US
Practice Address - Phone:903-968-2847
Practice Address - Fax:903-968-2216
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1605208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00DS78OtherBLUECROSS BLUESHIELD
TX133160504Medicaid
TX00QU29Medicare ID - Type UnspecifiedMEDICARE
TX00DS78OtherBLUECROSS BLUESHIELD