1285684704 NPI number — ROBERT STONE BAXT M.D.

Table of content: ROBERT STONE BAXT M.D. (NPI 1285684704)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285684704 NPI number — ROBERT STONE BAXT M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAXT
Provider First Name:
ROBERT
Provider Middle Name:
STONE
Provider Name Prefix Text:
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:
1285684704
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
515 FAIRMOUNT AVE
Provider Second Line Business Mailing Address:
CREDENTIALING DEPARTMENT
Provider Business Mailing Address City Name:
TOWSON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21286-5466
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-494-1324
Provider Business Mailing Address Fax Number:
410-494-1361

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
750 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
REISTERSTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21136-2515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-526-3051
Provider Business Practice Location Address Fax Number:
410-526-3091
Provider Enumeration Date:
05/12/2006

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: 208600000X , with the licence number:  D13335 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: D0013335 , 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: 252441400 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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