1679553358 NPI number — ANNA B BAER MD

Table of content: ANNA B BAER MD (NPI 1679553358)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679553358 NPI number — ANNA B BAER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAER
Provider First Name:
ANNA
Provider Middle Name:
B
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BLACKMON
Provider Other First Name:
ANNA
Provider Other Middle Name:
KATHRYN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1679553358
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
650 PETER JEFFERSON PKWY
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
CHARLOTTESVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22911-8844
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-293-4072
Provider Business Mailing Address Fax Number:
434-293-4265

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
650 PETER JEFFERSON PKWY
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
CHARLOTTESVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22911-8844
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-293-4072
Provider Business Practice Location Address Fax Number:
434-293-4265
Provider Enumeration Date:
01/19/2006

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: 207RC0000X , with the licence number:  0101237798 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 456179 . This is a "SOUTHERN HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 247332 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: C10061 . This is a "MEDICARE GROUP PIN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: P00384057 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1679553358 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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