Provider Demographics
NPI:1174554943
Name:BAGBY, LARA (MS, CGC)
Entity type:Individual
Prefix:MRS
First Name:LARA
Middle Name:
Last Name:BAGBY
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 MARYLAND RD APT O4
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1837
Mailing Address - Country:US
Mailing Address - Phone:215-828-9177
Mailing Address - Fax:
Practice Address - Street 1:801 SPRUCE ST
Practice Address - Street 2:8TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5701
Practice Address - Country:US
Practice Address - Phone:215-829-5580
Practice Address - Fax:215-829-5013
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS