1346246782 NPI number — DR. KONRAD W BAKKER M.D.

Table of content: DR. KONRAD W BAKKER M.D. (NPI 1346246782)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346246782 NPI number — DR. KONRAD W BAKKER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAKKER
Provider First Name:
KONRAD
Provider Middle Name:
W
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1346246782
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
172 THOMAS JOHNSON DR
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
FREDERICK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21702-4405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-694-0900
Provider Business Mailing Address Fax Number:
301-694-0657

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
172 THOMAS JOHNSON DR
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
FREDERICK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21702-4405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-694-0900
Provider Business Practice Location Address Fax Number:
301-694-0657
Provider Enumeration Date:
06/21/2005

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: 2084N0400X , with the licence number:  D0035322 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084S0012X , with the licence number: DOO35322 , 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: 0501704 . This is a "EVERCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 237076 . This is a "ANTHEM BC/BS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 372721 . This is a "MAMASI/MDIPA.OPT. CH. DME" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 4137502 . This is a "AETNA PPO/MC/EPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 495169 . This is a "NCPPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 186224 . This is a "COVENTRY" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 5113 . This is a "BC/BC OF DC" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 526711100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 613465 . This is a "MAMSI/MDIPA/OPT. CHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: ZC6139 . This is a "HEALTHNET" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1306711010 . This is a "CIGNA MD/VA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: KFE9CO . This is a "BC/BS OF MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 237074 . This is a "ANTHEM HEALTHKEEPERS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 3327089 . This is a "AETNA HMO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 3473625 . This is a "AETNA HMO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 500310 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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