Provider Demographics
NPI:1417991993
Name:BAIRD, CHRISTOPHER WALLACE (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:WALLACE
Last Name:BAIRD
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 1:300 LONGWOOD AVE
Mailing Address - Street 2:FA-144
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5724
Mailing Address - Country:US
Mailing Address - Phone:617-355-7932
Mailing Address - Fax:617-730-0214
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:FA-144
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-7932
Practice Address - Fax:617-730-0214
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2243982086S0120X, 208G00000X
NC2006-01140208G00000X, 2086S0120X
PAMD417984208G00000X, 2086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5904485Medicaid
NC143AEOtherBCBS
SCN00793Medicaid
NC5904485Medicaid
NC143AEOtherBCBS