Provider Demographics
NPI:1235745530
Name:BAYNARD, JAMES G
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:G
Last Name:BAYNARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21752 GELDING DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:DE
Mailing Address - Zip Code:19960-2516
Mailing Address - Country:US
Mailing Address - Phone:302-841-8763
Mailing Address - Fax:
Practice Address - Street 1:21752 GELDING DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:DE
Practice Address - Zip Code:19960-2516
Practice Address - Country:US
Practice Address - Phone:302-841-8763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE000000614Medicaid