Provider Demographics
NPI:1801100367
Name:BAGADE, SWAPNIL S (MD)
Entity type:Individual
Prefix:DR
First Name:SWAPNIL
Middle Name:S
Last Name:BAGADE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4485 BARAT HALL DR APT C6
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-2534
Mailing Address - Country:US
Mailing Address - Phone:404-558-3111
Mailing Address - Fax:
Practice Address - Street 1:1000 ASYLUM AVE
Practice Address - Street 2:SUITE 3201E
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1770
Practice Address - Country:US
Practice Address - Phone:203-714-2724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA46922085B0100X
MO2011015472085P0229X
CT541722085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology