Provider Demographics
NPI:1275699423
Name:BAUKNIGHT, S TERRY (PHD)
Entity Type:Individual
Prefix:
First Name:S
Middle Name:TERRY
Last Name:BAUKNIGHT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 FREDERICK ROAD
Mailing Address - Street 2:SUITE 251
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228
Mailing Address - Country:US
Mailing Address - Phone:410-788-3019
Mailing Address - Fax:410-788-3067
Practice Address - Street 1:405 FREDERICK ROAD
Practice Address - Street 2:SUITE 251
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228
Practice Address - Country:US
Practice Address - Phone:410-788-3019
Practice Address - Fax:410-788-3067
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD1486103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
G090Medicare ID - Type Unspecified