Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 0101052069 | VA |
N | 111NI0900X | Internist | 0101052069 | VA |
N | 207RG0300X | Geriatric Medicine | 0101052069 | VA |
N | 207RI0200X | Infectious Disease | 0101052069 | VA |
NPI | 1114129517 |
---|---|
Provider Name | Dr. William Brennan Baine |
First Address | Leesburg, VA 20178-7429 |
Second Address | Leesburg, VA 20176-4544 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2007 |
Last Update Date | 08/07/2007 |