Provider Demographics
NPI:1316300700
Name:REYES-BAUTISTA, JEANINE PAULETTE SIOSON (MD)
Entity type:Individual
Prefix:DR
First Name:JEANINE PAULETTE
Middle Name:SIOSON
Last Name:REYES-BAUTISTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JEANINE PAULETTE
Other - Middle Name:SIOSON
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1107 SOUTH CLINTON STREET
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-0005
Mailing Address - Country:US
Mailing Address - Phone:443-858-0047
Mailing Address - Fax:
Practice Address - Street 1:HOWARD COUNTY GENERAL HOSPITAL
Practice Address - Street 2:5755 CEDAR LANE
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044
Practice Address - Country:US
Practice Address - Phone:410-720-8769
Practice Address - Fax:410-740-7561
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-01
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0087274208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics