Provider Demographics
NPI:1346249026
Name:BAITHER, RICHARD C (PHD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:C
Last Name:BAITHER
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 1:8500 EXECUTIVE PARK AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2225
Mailing Address - Country:US
Mailing Address - Phone:703-698-5200
Mailing Address - Fax:703-573-2351
Practice Address - Street 1:8500 EXECUTIVE PARK AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2225
Practice Address - Country:US
Practice Address - Phone:703-698-5200
Practice Address - Fax:703-573-2351
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001356103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4231241OtherAETNA
VA105251-000OtherMAGELLAN
VA345093OtherMAMSI
445093OtherMAMSI
VA72463341OtherTRICARE
VA031140OtherVALUE OPTIONS
VA202939OtherANTHEM
VA513429OtherNCPPO
DC0009OtherCAREFIRST NCA
VA72463341OtherTRICARE