Provider Demographics
NPI:1245418607
Name:NORTH BAY ORTHOPAEDICS, LLC
Entity Type:Organization
Organization Name:NORTH BAY ORTHOPAEDICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:WATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-939-7077
Mailing Address - Street 1:421 S UNION AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-3300
Mailing Address - Country:US
Mailing Address - Phone:410-939-7077
Mailing Address - Fax:410-939-7983
Practice Address - Street 1:421 S UNION AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-3300
Practice Address - Country:US
Practice Address - Phone:410-939-7077
Practice Address - Fax:410-939-7983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207X00000X
MDD57143332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5474360001Medicare NSC