Provider Demographics
NPI:1336245323
Name:BAAKO, MICHAEL N (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:N
Last Name:BAAKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4737
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20914-4737
Mailing Address - Country:US
Mailing Address - Phone:240-295-0502
Mailing Address - Fax:240-295-0503
Practice Address - Street 1:3450 FORT MEADE RD
Practice Address - Street 2:SUITE 209
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20724-2040
Practice Address - Country:US
Practice Address - Phone:240-295-0502
Practice Address - Fax:240-295-0503
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0057216207R00000X
DEC1-0006365207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
8107145/ 2107145OtherMAMSI
667490OtherNCPPO
MD7457439OtherAETNA
0404202OtherUNITED HEALTHCARE
5455054OtherCCN NETWORK
MDH816-0001OtherBCBS NATIONAL CAPITAL
DC491525Medicare ID - Type Unspecified
667490OtherNCPPO
8107145/ 2107145OtherMAMSI
MD068SMedicare ID - Type Unspecified