Provider Demographics
NPI:1912961582
Name:BAGHERIAN, SHARAREH (DO)
Entity type:Individual
Prefix:DR
First Name:SHARAREH
Middle Name:
Last Name:BAGHERIAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 LONE STAR RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-8744
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2300 LONE STAR RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-8744
Practice Address - Country:US
Practice Address - Phone:661-433-5071
Practice Address - Fax:865-560-7382
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2210681207V00000X
TXV4809207V00000X
NY221068-1207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02158712Medicaid
H40811Medicare UPIN
NY02158712Medicaid