1093761322 NPI number — JENNIFER V BAIKAUSKAS MPT

Table of content: JENNIFER V BAIKAUSKAS MPT (NPI 1093761322)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093761322 NPI number — JENNIFER V BAIKAUSKAS MPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAIKAUSKAS
Provider First Name:
JENNIFER
Provider Middle Name:
V
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MPT
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:
1093761322
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 NICHOLAS ALEXANDER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT DEPOSIT
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21904-1012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
998 HOSPITALITY WAY
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
ABERDEEN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21001-1779
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-273-9776
Provider Business Practice Location Address Fax Number:
410-273-9777
Provider Enumeration Date:
05/26/2006

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: 225100000X , with the licence number:  19599 , 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: G6140018 . This is a "BS FEP & DC" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 61127103 . This is a "BS MARYLAND" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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