Provider Demographics
NPI:1134129117
Name:BAIRD, PHILLIP (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:
Last Name:BAIRD
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 1:489 5TH AVE
Mailing Address - Street 2:THRID FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-6109
Mailing Address - Country:US
Mailing Address - Phone:212-530-2288
Mailing Address - Fax:212-867-4353
Practice Address - Street 1:489 5TH AVE
Practice Address - Street 2:THRID FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6109
Practice Address - Country:US
Practice Address - Phone:212-530-2288
Practice Address - Fax:212-867-4353
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195764207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00903700Medicaid
NYG43581Medicare UPIN
NY00903700Medicaid