Provider Demographics
NPI:1184645301
Name:BAIK, RANIA (DO)
Entity Type:Individual
Prefix:
First Name:RANIA
Middle Name:
Last Name:BAIK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 ROUTE 169
Mailing Address - Street 2:PO BOX 865
Mailing Address - City:WOODSTOCK
Mailing Address - State:CT
Mailing Address - Zip Code:06281-2225
Mailing Address - Country:US
Mailing Address - Phone:860-821-3406
Mailing Address - Fax:860-821-3407
Practice Address - Street 1:602 ROUTE 169
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:CT
Practice Address - Zip Code:06281-2225
Practice Address - Country:US
Practice Address - Phone:860-821-3406
Practice Address - Fax:860-821-3407
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000260207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B84174Medicare UPIN
CT1002609Medicaid
080001365Medicare ID - Type Unspecified