Provider Demographics
NPI:1003895764
Name:BAYER-GARNER, ILENE B (MD)
Entity Type:Individual
Prefix:DR
First Name:ILENE
Middle Name:B
Last Name:BAYER-GARNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 BERRYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-2034
Mailing Address - Country:US
Mailing Address - Phone:443-926-4251
Mailing Address - Fax:
Practice Address - Street 1:285 BERRYWOOD DR
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-2034
Practice Address - Country:US
Practice Address - Phone:443-926-4251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0064386207ND0900X, 207ZD0900X
AL17922193200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No193200000XGroupMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALH87536Medicare UPIN