Provider Demographics
NPI: | 1376523795 |
---|---|
Name: | BAIO, MICHAEL VINCENT (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | MICHAEL |
Middle Name: | VINCENT |
Last Name: | BAIO |
Suffix: | |
Gender: | M |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 2010 W CHESTER PIKE |
Mailing Address - Street 2: | SUITE 344 |
Mailing Address - City: | HAVERTOWN |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 19083-2700 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 610-449-3600 |
Mailing Address - Fax: | 610-449-3305 |
Practice Address - Street 1: | 2010 W CHESTER PIKE |
Practice Address - Street 2: | SUITE 344 |
Practice Address - City: | HAVERTOWN |
Practice Address - State: | PA |
Practice Address - Zip Code: | 19083-2700 |
Practice Address - Country: | US |
Practice Address - Phone: | 610-449-3600 |
Practice Address - Fax: | 610-449-3305 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2006-01-20 |
Last Update Date: | 2013-11-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | MD033225E | 207R00000X, 311Z00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | |
No | 311Z00000X | Nursing & Custodial Care Facilities | Custodial Care Facility |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
PA | BA473786 | Medicare ID - Type Unspecified | |
PA | C34507 | Medicare UPIN |