Provider Demographics
NPI:1528242955
Name:DR. WILLIAM E. BAIR LLC
Entity type:Organization
Organization Name:DR. WILLIAM E. BAIR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:HURST
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-228-4616
Mailing Address - Street 1:100 BRAMBLE ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-2471
Mailing Address - Country:US
Mailing Address - Phone:410-228-4616
Mailing Address - Fax:410-901-1008
Practice Address - Street 1:100 BRAMBLE ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-2471
Practice Address - Country:US
Practice Address - Phone:410-228-4616
Practice Address - Fax:410-901-1008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF35394Medicare UPIN
MD329MMedicare PIN