1508979808 NPI number — JOHN C BAER MD LLC

Table of content: (NPI 1508979808)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508979808 NPI number — JOHN C BAER MD LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN C BAER MD LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1508979808
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
250 E WALNUT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HANOVER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17331-2534
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-632-6063
Provider Business Mailing Address Fax Number:
717-632-8337

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 E WALNUT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HANOVER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17331-2534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-632-6063
Provider Business Practice Location Address Fax Number:
717-632-8337
Provider Enumeration Date:
08/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BAER
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OWNER PHYSICIAN
Authorized Official Telephone Number:
717-632-6063

Provider Taxonomy Codes

  • Taxonomy code: 152WC0802X , with the licence number:  OE001116 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152WC0802X , with the licence number: TA0952 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: MD418856 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: MD06890L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: D0029740 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 01399171 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3821719 . This is a "AETNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 50000869 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: DA3122 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: T274 . This is a "CAREFIRST BSBC NAT CAP AR" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: DA3126 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: JO1414870 . This is a "HIGHMARK BS OPTOMETRY GRP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: T274 . This is a "CAREFIRST BLUE CHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1308JC . This is a "CAREFIRST BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 4121977 . This is a "AETNA PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3190310 . This is a "AETNA HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 433851101 . This is a "MEDICAID OPTICS LTD LOCA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 10077025800004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007705800005 . This is a "MEDICAID OPTOMETRY GROUP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 433851100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50000869 . This is a "KEYSTONE HPC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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