Provider Demographics
NPI:1043203664
Name:BAIG, AZAM (MD)
Entity Type:Individual
Prefix:
First Name:AZAM
Middle Name:
Last Name:BAIG
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 1:224A MAYO ROAD
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:MD
Mailing Address - Zip Code:21037
Mailing Address - Country:US
Mailing Address - Phone:410-956-6303
Mailing Address - Fax:410-956-6637
Practice Address - Street 1:224A MAYO ROAD
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:MD
Practice Address - Zip Code:21037
Practice Address - Country:US
Practice Address - Phone:410-956-6303
Practice Address - Fax:410-956-6637
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-30
Last Update Date:2007-07-08
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
MDD0020882208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
04354000000OtherPHN
494675OtherNCPPO
1200045OtherUNITED HEALTHCARE
0453912OtherAETNA US HEALTHCARE
2653AOtherBLUECROSS/BLUESHIELD
38981OtherMAMSI
0701078005OtherCIGNA
04531OtherAMERICAID
C023OtherBLUE CHOICE
0453912OtherAETNA US HEALTHCARE