1093704553 NPI number — LISA H BAYLES CRNP

Table of content: LISA H BAYLES CRNP (NPI 1093704553)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093704553 NPI number — LISA H BAYLES CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAYLES
Provider First Name:
LISA
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093704553
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10026 OLD OCEAN CITY BLVD
Provider Second Line Business Mailing Address:
BUILDING ONE
Provider Business Mailing Address City Name:
BERLIN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21811-1288
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-641-9450
Provider Business Mailing Address Fax Number:
410-641-9515

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10231 OLD OCEAN CITY BLVD
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
BERLIN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21811-3568
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-629-6870
Provider Business Practice Location Address Fax Number:
410-641-3140
Provider Enumeration Date:
10/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LX0001X , with the licence number:  R060296 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 552105000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com