Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0120X | Pediatric Surgery | 2006-01140 | NC |
N | 2086S0120X | Pediatric Surgery | 224398 | MA |
N | 2086S0120X | Pediatric Surgery | MD417984 | PA |
N | 208G00000X | Cardiothoracic Vascular Surgeon | 2006-01140 | NC |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 224398 | MA |
N | 208G00000X | Cardiothoracic Vascular Surgeon | MD417984 | PA |
NPI | 1417991993 |
---|---|
Provider Name | Christopher Wallace Baird |
First Address | Boston, MA 02115-5724 |
Second Address | Boston, MA 02115-5724 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 28/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
143AE | BCBS (01) | NC |
5904485 | (05) | NC |
I59236 | (02) | |
N00793 | (05) | SC |