Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | D0052701 | MD |
NPI | 1003826801 |
---|---|
Provider Name | Heike Barbara Bailin |
First Address | Gaithersburg, MD 20879-3584 |
Second Address | Gaithersburg, MD 20879-3584 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D0052701 | STATE LICENSURE (01) | MD |
H53138 | (02) | MD |
M43959 | STATE OF MARYLAND CDS (01) | MD |