Provider Demographics
NPI:1033393871
Name:BAKSH, WAHEED S (MD, DPT)
Entity Type:Individual
Prefix:MR
First Name:WAHEED
Middle Name:S
Last Name:BAKSH
Suffix:
Gender:M
Credentials:MD, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 TAVERN RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-2864
Mailing Address - Country:US
Mailing Address - Phone:304-263-6165
Mailing Address - Fax:304-263-6536
Practice Address - Street 1:1839 WEST PLAZA DRIVE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601
Practice Address - Country:US
Practice Address - Phone:540-773-2689
Practice Address - Fax:540-468-4166
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60267385208100000X
GA068103208100000X
VA0101254060208100000X, 2081P2900X
MDD00878462081P2900X
WV25285208VP0000X, 2081P2900X
NY029209225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101254060OtherMEDICAL LICENSE
WV25285OtherWEST VIRGINIA BOARD OF MEDICINE
MDD0087846OtherMARYLAND BOARD OF PHYSICIANS