1043203664 NPI number — AZAM BAIG MD

Table of content: AZAM BAIG MD (NPI 1043203664)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043203664 NPI number — AZAM BAIG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAIG
Provider First Name:
AZAM
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1043203664
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/23/2006
NPI Reactivation Date:
03/27/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
224A MAYO ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDGEWATER
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-956-6303
Provider Business Mailing Address Fax Number:
410-956-6637

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
224A MAYO ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDGEWATER
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-956-6303
Provider Business Practice Location Address Fax Number:
410-956-6637
Provider Enumeration Date:
08/30/2005

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: 208000000X , with the licence number:  D0020882 , 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: 04354000000 . This is a "PHN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 494675 . This is a "NCPPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1200045 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0453912 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2653A . This is a "BLUECROSS/BLUESHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 38981 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0701078005 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 04531 . This is a "AMERICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: C023 . This is a "BLUE CHOICE" identifier . This identifiers is of the category "OTHER".




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