Provider Demographics
NPI:1104824465
Name:SHABAZZ, BAYINNAH (MD)
Entity Type:Individual
Prefix:DR
First Name:BAYINNAH
Middle Name:
Last Name:SHABAZZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1589 SULPHUR SPRING RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-2542
Mailing Address - Country:US
Mailing Address - Phone:410-536-5400
Mailing Address - Fax:410-737-2168
Practice Address - Street 1:808 LANDMARK DR
Practice Address - Street 2:SUITE 122
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4983
Practice Address - Country:US
Practice Address - Phone:410-760-3588
Practice Address - Fax:410-760-3604
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2011-03-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD24592207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD269581200Medicaid
MDB69748Medicare UPIN
MD269581200Medicaid