Provider Demographics
NPI:1417088808
Name:BAQUERO, ASHLEY (MD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:BAQUERO
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 1:100 EUROPA DR
Mailing Address - Street 2:SUITE 180
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-2357
Mailing Address - Country:US
Mailing Address - Phone:919-929-6777
Mailing Address - Fax:919-929-6577
Practice Address - Street 1:100 EUROPA DR
Practice Address - Street 2:SUITE 180
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-2357
Practice Address - Country:US
Practice Address - Phone:919-929-6777
Practice Address - Fax:919-929-6577
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101034868208600000X
NC2010012982086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1417088808Medicaid
VA309084OtherANTHEM
NC2076742Medicare PIN
VA309084OtherANTHEM
NCDE0112Medicare PIN
VA016588S01Medicare PIN